2025-11-03T10:32:43-06:00 2024-12-31 273858252 DEAN DORTON ALLEN FORD PLLC 810 WRIGHTS SUMMIT PARKWAY SUITE 300 FORT WRIGHT KY 41011 990 2024-01-01 611297707 CCMH CORPORATION CCMH 5023053375 309 ELEVENTH STREET CARROLLTON KY 41008 JENNIFER LITER CEO 5027323275 2025-11-01 1 0 BRYAN PAUTSCH P00034913 8593313300 2025-11-01 2024 2025-03-06 01:10:19Z KIM HAVERLY 309 ELEVENTH STREET CARROLLTON KY 41008 29919754 0 X WWW.CCMHOSP.COM X 2007 KY PROVIDE A HEALTHCARE FACILITY OFFERING ACUTE CARE, SKILLED CARE, OUTPATIENT SERVICES, AND EMERGENCY MEDICAL SERVICES TO RESIDENTS OF CARROLL COUNTY, KENTUCKY AND SURROUNDING AREAS. 12 12 243 13 0 0 1971207 212410 20238478 24459747 169119 23381 4575027 5224216 26953831 29919754 0 0 0 0 12747206 14039255 0 0 0 12072942 14627673 24820148 28666928 2133683 1252826 15791365 16345824 8568409 7870042 7222956 8475782 PROVIDE A HEALTHCARE FACILITY OFFERING ACURE CARE, SKILLED CARE, OUTPATIENT SERVICES, AND EMERGENCY MEDICAL SERVICES TO RESIDENTS OF CARROLL COUNTY, KENTUCKY AND SURROUNDING AREAS. 0 0 26946913 29612523 SERVICED 48,310 PATIENTS THIS YEAR. APPROXIMATELY 7,499 PATIENTS WERE SERVICED IN EMERGENCY ROOMS. ALSO HAD 20,584 PHYSICIAN CLAIMS. 26946913 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 47 0 243 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 KY X THE ORGANIZATION 5027323275 309 ELEVENTH ST CARROLLTON KY 41008 DENNIS RAISOR PRESIDENT 1.00 X X 0 0 0 JAMES STEPHENSON SECRETARY 1.00 X X 0 0 0 ROBERT YOWLER BOARD MEMBER 1.00 X 0 0 0 SCOTT NAB BOARD MEMBER 1.00 X 0 0 0 LAMAN STARK BOARD MEMBER 1.00 X 0 0 0 JOHN WRIGHT BOARD MEMBER 1.00 X 0 0 0 HAROLD TOMLINSON BOARD MEMBER 1.00 X 0 0 0 NICK MARSH BOARD MEMBER 1.00 X 0 0 0 DAVID WILHOITE BOARD MEMBER 1.00 X 0 0 0 CAROLYN WILLIAMS BOARD MEMBER 1.00 X 0 0 0 JODI KEMPER BOARD MEMBER 1.00 X 0 0 0 JOHN OGBURN BOARD MEMBER 1.00 X 0 0 0 KIM HAVERLY CHIEF FINANCIAL OFFICER 40.00 X 234440 0 0 DR WINSTON YAP MEDICAL STAFF PRESIDENT 1.00 X 240735 0 0 RANJHAN GOPANG PHYSICIAN 40.00 X 843463 0 33523 PATRICIA FIGERT SURGEON 40.00 X 400999 0 0 SHERRELL NUNNELLEY PHYSICIAN 40.00 X 263686 0 10476 HERB HUNTER PHYSICIAN 40.00 X 166160 0 36186 2149483 0 80185 14 0 1 0 SENIOR HEALTH SERVICES 2932 BRECKENRIDGE LANE STE 5 LOUISVILLE KY 40220 SENIOR SERVICES 308505 TRUBRIDGE PO BOX 850309 MOBILE AL 36685 EMR SYSTEMS 261905 MEDICAL SOLUTIONS PO BOX 850737 MINNEAPOLIS MN 55485 MEDICAL SERVICES 234425 CONCORD COMPANY OF TN 1602 AVENUE Q LUBBOCK TX 79401 EMERGENCY MEDICINE 215512 BECKMAN COULTER 250 SOUTH KRAEMER BOULEVARD BREA CA 928216232 CONSULTING 197508 10 212410 212410 PATIENT SERVICE REVENUE 621990 24459747 24459747 24459747 23381 23381 105846 0 105846 105846 105846 MEDICAID HRIP 621110 4746427 4746427 MISCELLANEOUS 621110 223659 152219 71440 340B PROGRAM 621110 148284 148284 5118370 29919754 29612523 0 94821 234440 220374 14066 11623066 10925682 697384 1376378 1293795 82583 805371 757049 48322 8697 8175 522 60349 56728 3621 2439887 2293494 146393 29461 27693 1768 657190 617759 39431 44113 41466 2647 161442 151755 9687 857806 806338 51468 389216 365863 23353 MEDICAL SUPPLIES AND DR 3473165 3264775 208390 BAD DEBT 3437736 3231472 206264 PHYSICIAN FEES 1801166 1693096 108070 OTHER EXPENSES 694022 652381 41641 573423 539018 34405 28666928 26946913 1720015 0 6701156 6310201 17543 1028736 1883584 1941671 258722 288528 215390 278480 23663732 17885158 5973068 5778574 741902 719634 15791365 16345824 2529598 1973364 5650355 5523018 388456 373660 8568409 7870042 X 7222956 8475782 7222956 8475782 15791365 16345824 1252826 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1226203 1226203 9624526 8942579 681947 12813003 8942579 3870424 5778574 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 346154 CURRENT PORTION OF OPERATING LEASES 27506 373660 X 26482018 0 26482018 3437736 3437736 29919754 25229192 0 25229192 3437736 3437736 28666928 PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS A TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL RECOGNIZES UNCERTAIN TAX POSITIONS USING THE "MORE LIKELY THAN NOT" APPROACH AS DEFINED IN THE ASC. NO LIABILITY FOR UNCERTAIN TAX POSITIONS HAS BEEN RECORDED IN THE ACCOMPANYING FINANCIAL STATEMENTS. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 3,437,736. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 3,437,736. 1 1 X 1 X 1 X 1 1 0 1 1 3190469 4746426 0 0.00000 9861386 6453626 3407760 0.11890 13051855 11200052 3407760 0.11890 13051855 11200052 3407760 0.11890 1 3437736 6041103 5392623 648480 X 1 1 1 1 CARROLL COUNTY MEMORIAL HOSPITAL 309 ELEVENTH STREET CARROLLTON KY 41008 WWW.CCMHOSP.COM KENTUCKY 600061 X X X X CARROLL COUNTY MEMORIAL HOSPITAL 0 0 1 X X X X X X X X X 22 1 0 0 1 X WWW.CCMHOSP.COM/ABOUT-US/HOSPITAL-INFORMATION X 1 22 1 WWW.CCMHOSP.COM/ABOUT-US/HOSPITAL-INFORMATION 0 1 X 100.000000000000 200.000000000000 X X X 1 1 X X X 1 X WWW.CCMHOSP.COM/FINANCIAL-INFORMATION X WWW.CCMHOSP.COM/FINANCIAL-INFORMATION X WWW.CCMHOSP.COM/FINANCIAL-INFORMATION X X X 1 X 0 X X 1 0 0 CARROLL COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: THE COMMUNITY STEERING COMMITTEE IS A VITAL PART TO THE CHNA PROCESS. THESE INDIVIDUALS REPRESENT ORGANIZATIONS AND AGENCIES FROM THE SERVICE AREA AND IN PARTICULAR, THE INDIVIDUALS WHO WERE WILLING TO VOLUNTEER ENABLED THE HOSPITAL TO GET INPUT FROM POPULATIONS THAT WERE OFTEN NOT ENGAGED IN CONVERSATIONS ABOUT THEIR HEALTH NEEDS. CEDIK PROVIDED A LIST OF POTENTIAL AGENCIES AND ORGANIZATIONS THAT WOULD FACILITATE BROAD INPUT. THE COMMUNITY STEERING COMMITTEE MET TWICE AS A GROUP AND EACH TIME A HOSPITAL REPRESENTATIVE WELCOMED AND THANKED THE INDIVIDUALS FOR ASSISTING IN THE PROCESS AND THEN EXCUSED THEMSELVES IF FOCUS GROUP DISCUSSION WAS BEING CONDUCTED. CEDIK ASKED THAT HOSPITAL REPRESENTATIVES NOT BE PRESENT DURING ANY FOCUS GROUP DISCUSSIONS OR DEBRIEFING WITH THE COMMUNITY STEERING COMMITTEE.COMMUNITY STEERING COMITTEE MEMBERS:HEATHER YOCUM KCTCS, CARROLLTON CAMPUS SITE DIRECTOR MATTHEW ADKINS KIEDA, DIRECTOR LINDA DAVIS BUSINESS OWNER, COMMUNITY REPRESENTATIVEALYSSA CASPER DOW CHEMICAL, INDUSTRY REPRESENTATIVE PATRICK CASPER DOW CHEMICAL, INDUSTRY REPRESENTATIVE RUSTY BENNETT - RELEVANT CHURCH, PASTOR JAKE THOMPSON - CBKY LAWDENISE HALL - TRIMBLE CARES COLITION KIMBERLY HAVERLY - CARROLL COUNTY MEMORIAL HOSPITAL CEO JILL GOODMAN CARROL COUNTY MEMORIAL HOSPITAL DIRECTOR OF ANCILLARY SERVICES SHELIA TOMLINSON - CARROLL COUNTY MEMORIAL HOSPITAL DIRECTOR OF PHYS CLINICS LOGAN MORGAN - CARROLL COUNTY MEMORIAL HOSPITAL EXECUTIVE ASSISTANT ASHLEY JOHNSON - CARROLL COUNTY MEMORIAL HOSPITAL HUMAN RESOURSE MGR. CARROLL COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: PROMOTING CURRENT HOSPITAL RESOURCES AVAILABLE: THE CEO AND HR MARKETING MANAGER ARE WORKING CLOSING WITH AFFILIATED ORGANIZATION'S MARKETING DEPARTMENTS TO INCREASE COMMUNITY AWARENESS ON PROGRAMS THE FACILITY OFFERS. OUTSIDE MARKETING FIRMS ARE ALSO BEING REVIEWED TO ASSIST WITH PROMOTING SUBSTANCE ABUSE PROGRAMS THAT CCMH CURRENTLY HAS AVAILABLE. THE COMMUNITIES WE SERVE HAVE DIVERSE DEMOGRAPHICS, SO ADDITIONAL FOCUS IS BEING GIVEN TO PROPER COMMUNICATION STYLES FOR DIFFERING GENERATIONS. CCMH HAS TRANSPORTATION OPTIONS AND OVERALL GOOD QUALITY SCORES, SO ENSURING GENERAL POPULATION AWARENESS OF THESE FACTS AS WELL. EXPANDING MENTAL HEALTH TREATMENT OPTIONS: CCMH IS PURSING POSSIBILITIES IN THIS AREA BY LOOKING TO OFFER INPATIENT TREATMENT OPTIONS, OPTIONS FOR ADOLESCENTS, AS WELL AS HOLDING COMMUNITY EVENTS TO INCREASE EDUCATION ON MENTAL HEALTH. CCMH CURRENTLY OFFERS COUNSELING FOR ADULTS, AND INPATIENT MEDICAL STABILIZATION FOR PEOPLE LOOKING TO ENTER TREATMENT OPTIONS.HEALTH EDUCATION: CCMH IS WORKING WITH MARKETING FIRMS TO INCLUDE PERTINENT INFORMATION ON OUR WEBSITE TO CONNECT PATIENTS WITH PROVIDERS AND PROPER TREATMENT OPTIONS. FOCUS ON HIGHLIGHTING PHYSICIANS AND TREATMENT TYPES AND EDUCATION TO THE GENERAL PUBLIC THROUGH USE OF VARIOUS MARKETING TECHNIQUES. CCMH IS WORKING WITH AFFILIATE AND OUTSIDE MARKETING FIRMS TO IMPROVE AND EXPAND ITS ONLINE PRESENCE. ADDITIONALLY, CCMH WILL CONDUCT COMMUNITY EVENTS ON NUTRITION EDUCATION, GENERAL HYGIENE AND OTHER HEALTH EDUCATION TOPICS. EXPAND SPECIALTY CARE AVAILABILITY: CCMH HAS ENTERED INTO A STRATEGIC PARTNERSHIP WITH UOFL HEALTH IN 2022. ADDITIONAL SPECIALTIES ADDED IN THE LAST 12 MONTHS INCLUDE VASCULAR SURGERY, PODIATRY, ADDITIONAL CARDIOLOGY SERVICES. SERVICES SCHEDULED TO ONBOARD IN 2024 INCLUDE OB/GYN, ENT, AND SPORTS MEDICINE. OTHER SPECIALTIES ARE CURRENTLY BEING EVALUATED. 3 1 - BEDFORD FAMILY PRACTICE 470 HIGHWAY 421 NORTH BEDFORD KY 40006 PROVIDED BASED RURAL HEALTH CLINIC 2 - WARSAW FAMILY PRACTICE 202 FRANKLIN STREET WARSAW KY 41095 PROVIDED BASED RURAL HEALTH CLINIC 3 - CARROLL COUNTY RURAL HEALTH CLINIC 309 ELEVENTH STREET CARROLLTON KY 41008 PROVIDED BASED RURAL HEALTH CLINIC PART I, LINE 7: THE ORGANIZATION USED THE MEDICARE COST TO CHARGE RATIO TO COMPLETE PART I LINE 7. PART III, LINE 2: IN DETERMINING THE AMOUNT OF BAD DEBT AT COST, THE ORGANIZATON USED THE MEDICARE COST REPORT (MCR), COST TO CHARGE RATIO OF 36.8% PART III, LINE 3: PATIENT ACCOUNTS RECEIVABLE ARE STATED AT NET REALIZABLE AMOUNTS FROM PATIENTS, THIRDPARTY PAYORS AND OTHERS FOR SERVICES RENDERED. THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS, WHICH IS MANAGEMENT'S ESTIMATE BASED UPON HISTORICAL COLLECTION INFORMATION AND OTHER INDUSTRY TRENDS. PATIENT ACCOUNTS RECEIVABLE ARE BILLED UPON DISCHARGE AND ARE ORDINARILY DUE WITHIN 30 DAYS OF BILLING. BALANCES MORE THAN 120 DAYS PAST DUE ARE CONSIDERED DELINQUENT. DELINQUENT RECEIVABLES ARE TURNED OVER TO A COLLECTION AGENCY. PART III, LINE 4: A SEPARATE FOOTNOTE FOR BAD DEBT EXPENSE IS NOT INCLUDED IN THE AUDITED FINANCIAL STATEMENTS.PATIENT ACCOUNTS RECEIVABLE ARE STATED AT NET REALIZABLE AMOUNTS FROM PATIENTS, THIRDPARTY PAYORS AND OTHERS FOR SERVICES RENDERED. THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS, WHICH IS MANAGEMENT'S ESTIMATE BASED UPON HISTORICAL COLLECTION INFORMATION AND OTHER INDUSTRY TRENDS. PATIENT ACCOUNTS RECEIVABLE ARE BILLED UPON DISCHARGE AND ARE ORDINARILY DUE WITHIN 30 DAYS OF BILLING. BALANCES MORE THAN 120 DAYS PAST DUE ARE CONSIDERED DELINQUENT. DELINQUENT RECEIVABLES ARE TURNED OVER TO A COLLECTION AGENCY. IN DETERMINING THE AMOUNT OF BAD DEBT AT COST, THE ORGANIZATION USED THE MEDICARE COST REPORT (MCR), COST TO CHARGE RATIO OF 36.8%. PART III, LINE 9B: THE ORGANIZATION'S COLLECTION POLICY STATES THAT ANY PERSON INDICATING AN INABILITY TO PAY WILL BE SCREENED FOR FINANCIAL ASSISTANCE. PART VI, LINE 2: INPUT FROM COMMUNITY LEADERS, BOARD MEMBERS, EMPLOYEES AND PATIENTS. HOSPITAL ADMINISTRATOR IS A MEMBER OF SEVERAL LOCAL ORGANIZATIONS (ROTARY, ECONOMIC DEVELOPMENT, ETC.). PART VI, LINE 3: FINANCIAL COUNSELORS ASSIST THOSE WITHOUT INSURANCE INCLUDING THOSE WITH INSURANCE THAT EXPRESS A NEED FOR FINANCIAL ASSISTANCE PART VI, LINE 4: THE ORGANIZATION SERVES A LARGELY RURAL POPULATION. COMMERCE IS CENTERED AROUND THE OHIO RIVER AND INDUSTRIES RELATED TO SUCH. THE POPULATION IS GENERALLY POORER THAN THE STATE AVERAGE WITH HIGHER THAN AVERAGE UNEMPLOYMENT. PART VI, LINE 5: HOSPITAL SPONSORED COMMUNITY HEALTH FAIR OFFERING SCREENINGS, PREVENTATIVE EDUCATION, AND INFORMATION TO PROMOTE GOOD HEALTH. COVID EDUCATION AND BEHAVIORAL HEALTH EDUCATION TO THE COMMUNITY. BOARD OF DIRECTORS REPRESENT THE ENTIRE COMMUNITY AND WORK WITH THE HOSPITAL TO PROMOTE AND PROVIDE HEALTHY COMMUNITY BENEFITS.HOSPITAL WORKS WITH COUNTY HEALTH DEPARTMENT TO PROMOTE HEALTHY LIVING AND PREVENTION. X X 0 0 0 0 0 0 0 1 0 RANJHAN GOPANG PHYSICIAN 456565 0 386898 0 0 0 0 0 33523 0 876986 0 0 0 PATRICIA FIGERT SURGEON 399999 0 1000 0 0 0 0 0 0 0 400999 0 0 0 SHERRELL NUNNELLEY PHYSICIAN 258519 0 5167 0 0 0 0 0 10476 0 274162 0 0 0 DR WINSTON YAP MEDICAL STAFF PRESIDENT 222060 0 18675 0 0 0 0 0 0 0 240735 0 0 0 KIM HAVERLY CHIEF FINANCIAL OFFICER 208787 0 25653 0 0 0 0 0 0 0 234440 0 0 0 HERB HUNTER PHYSICIAN 165160 0 1000 0 0 0 0 0 36186 0 202346 0 0 0 PART I, LINE 7 PHYSICIANS ARE ELIGIBLE FOR BONUSES BASED ON PRODUCTIVITY. FORM 990, PART VI, SECTION B, LINE 11B THE ACCOUNTING MANAGER REVIEWS THE 990 AND THEN THE 990 IS DISTRIBUTED TO THE GOVERNING BODY PRIOR TO ITS FILING. FORM 990, PART VI, SECTION B, LINE 12C MEMBERS OF CARROLL COUNTY MEMORIAL HOSPITAL'S ADVISORY BOARD, CCMH CORPORATION, OWE A DUTY OF CARE AND A DUTY OF LOYALTY TO CARROLL COUNTY MEMORIAL HOSPITAL, WHICH REQUIRE EACH DIRECTOR TO ACT IN GOOD FAITH, ON AN INFORMED BASIS, AND IN A MANNER THAT THE DIRECTOR HONESTLY BELIEVES TO BE IN THE BEST INTEREST OF CARROLL COUNTY MEMORIAL HOSPITAL. EACH MEMBER OF THE ADVISORY BOARD OF CARROLL COUNTY MEMORIAL HOSPITAL AND ITS AFFILIATED ORGANIZATIONS, CARROLL COUNTY MEMORIAL HOSPITAL OR SUBCOMMITTEES OF THESE BOARDS THAT HAVE BOARD DELEGATED POWERS SHALL FULLY AND ACCURATELY COMPLETE CARROLL COUNTY MEMORIAL HOSPITAL'S CONFLICT OF INTEREST DISCLOSURE FORM. THE FORM IS COMPLETED ANNUALLY. IF A BOARD MEMBER HAS CONFLICT, THE BOARD MEMBER CANNOT VOTE ON THE ISSUE. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF THE CEO IS REVIEWED, DETERMINED AND APPROVED BY THE CCMH BOARD OF DIRECTORS. IT IS PART OF AN EMPLOYMENT CONTRACT CONTRACT FOR THE CEO. COMPARATIVE DATA FOR A HOSPITAL OF THIS SIZE AND IN THIS GEOGRAPHIC AREA ARE USED AMONG OTHER FACTORS. SALARY ADJUSTMENT IS REVIEWED ANNUALLY BY THE BOARD. THE CONTRACT IS REVIEWED EVERY THREE YEARS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENT AVAIALBEL TO THE PUBLIC UPON REQUEST.