2015-03-16T10:06:12-05:00 2014-04-30 BKD LLP 360 E 8TH AVE STE 201 PO BOX 1196 BOWLING GREEN KY 421021196 990 2013-05-01 610471581 TRIGG COUNTY HOSPITAL INC % DIANA PHILLIPS TRIG 2705223215 254 MAIN ST Suite CADIZ KY 42211 DAVID SHORE CEO 2705223215 2015-03-13 true KIM SCIFRES P01316095 2705223215 2013 2016-04-25 22:37:26Z DAVID SHORE CEO 254 MAIN STREET CADIZ KY 42211 15584083 false X WWW.TRIGGHOSPITAL.ORG X 1952 KY TO PROVIDE QUALITY HEALTHCARE SERVICES IN a caring and cost-effective manner. WE PLEDGE TO MEET STANDARDS OF EXCELLENCE WHILE CONTINUOUSLY IMPROVING THE VALUE OF OUR SERVICE. 12 12 222 78 0 0 694120 627686 13029022 14856659 3792 4176 529674 76392 14256608 15564913 0 0 0 0 7456720 8541846 0 0 0 6068247 6871952 13524967 15413798 731641 151115 8084280 9363159 5548593 6676357 2535687 2686802 TO PROVIDE QUALITY HEALTHCARE SERVICES IN A CARING AND COST-EFFECTIVE MANNER. IN ACHIEVING OUR MISSION, WE PLEDGE TO MEET STANDARDS OF EXCELLENCE WHILE CONTINUOUSLY IMPROVING THE VALUE OF OUR SERVICE. false false 13950084 14862235 Our mission is to provide quality healthcare services in a caring and cost-effective manner. In achieving our mission, we pledge to meet standards of excellence while continuously improving the value of our service. The Hospital provides inpatient, outpatient, and emergency care services to patients in the Trigg County, Kentucky area. 13950084 true true false true false false false false false false true false false false true false true false 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 false false false true 54 0 true 222 true false false false false false false false false false false X 12 12 false false false false false false false true true false false true true true true true true true true false KY X DIANA PHILLIPS 2705223215 254 MAIN STREET CADIZ KY 42211 DR MICHAEL GROSS CHAIRMAN 1.0 X X 0 0 0 GEORGE RADFORD SECRETARY/TREASURER 1.0 X X 0 0 0 STEPHANIE PERRY BOARD MEMBER 1.0 X 0 0 0 MIKE WRIGHT BOARD MEMBER 1.0 X 0 0 0 BOB CASSITY BOARD MEMBER 1.0 X 0 0 0 BOB NOEL BOARD MEMBER 1.0 X 0 0 0 BEN CUNDIFF BOARD MEMBER 1.0 X 0 0 0 MALLORY LAWRENCE BOARD MEMBER 1.0 X 0 0 0 SHEA GODWIN MD BOARD MEMBER/ER PHYSICIAN 1.0 X 0 0 0 CLARA BETH HYDE BOARD MEMBER 1.0 X 0 0 0 ERIC BLEIDT BOARD MEMBER 1.0 X 0 0 0 JESSE THOMAS VICE CHAIRMAN 1.0 X X 0 0 0 ALISA B COLEMAN CEO 40.0 X 181228 0 12751 DIANA PHILLIPS CFO 40.0 X 91462 0 5063 CLIFFORD POPPENS PHYSICIAN 36.0 X 213422 0 5612 DAVID RUTLAND DIRECTOR OF PHARMACY 40.0 X 136694 0 12506 HOLLY MCCORMICK NURSE PRACTITIONER 40.0 X 111981 0 5203 JAMES BRAZIL PHYSICIAN 32.0 X 223136 0 6383 JULIE FORBUSH PHYSICIAN 36.0 X 100772 0 0 1058695 0 47518 6 false true false BLUEGRASS PHYSICIANS ECI PO BOX 674579 DETROIT MI 482674579 ER PHYSICIANS 1466774 DIAMOND HEALTHCARE GROUP PO BOX 85050 RICHMOND VA 23285 BEHAVORIAL HEALTH 249540 CPSI 6600 WALL STREET MOBILE AL 36695 BILLING 257300 QUORUM HEALTH RESOURCES 105 CONTINENTAL PLACE BRENTWOOD TN 370271018 MANAGEMENT SERVICES 210885 SYSTEM SOLUTIONS 115 CARLISLE COURT PADUCAH KY 42001 IT EQUPIMENT SUPPORT 229604 9 597407 30279 627686 Net Patient Service Revenue 621110 13750693 13750693 340B Program Revenue 621110 730048 730048 EHR INCENTIVE 900099 375918 375918 14856659 4176 4176 0 0 46893 19170 27723 0 27723 27723 0 0 0 0 Life Line 900099 5576 5576 Cafeteria 722210 35179 35179 All Other Misc Revenue 900099 7914 7914 48669 15564913 14862235 74992 0 0 0 0 290503 290503 0 6555430 6342283 213147 109467 101414 8053 1107597 1026112 81485 478849 443620 35229 210885 210885 81433 81433 0 2501 2501 0 0 2875590 2830289 45301 55898 54856 1042 647103 623456 23647 0 0 399851 389945 9906 67062 33420 33642 0 0 70002 70002 0 690444 690444 217767 217767 Medical Supplies 803984 798639 5345 Accounting Collections 157150 -1725 158875 Maintenance & Repair 261483 261425 58 Provider Tax 131717 131717 199082 151686 47396 15413798 13950084 1463714 0 486494 397606 141184 141776 0 0 2331687 2322693 0 0 0 0 74291 2122 106039 125547 142235 197750 12513297 6523121 4799831 5990176 0 0 0 0 0 0 0 0 2519 185489 8084280 9363159 2390018 2708597 0 0 0 10715 0 0 0 0 0 0 2895148 3488736 0 0 263427 468309 5548593 6676357 X 4787964 -28885 -2252277 2715687 0 0 2535687 2686802 8084280 9363159 151115 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X false false false false false false false false true 2501 2501 false false SCH. C, PART II-B, LINE I ------------------- A PORTION OF THE ORGANIZATION'S KHA & AHA DUES ARE USED FOR LOBBYING ACTIVITIES. 66000 66000 6004846 2508733 3496113 6442451 4014388 2428063 5990176 0 DUE TO THIRD PARTY PAYERS 468309 468309 X 15584083 19170 19170 15564913 15564913 15432968 19170 19170 15413798 15413798 FORM 990, SCH. D, PART XI, LINE 2D RECONCILIATION OF REVENUE ------------------------- OTHER REVENUE ON BOOKS BUT NOT ON RETURN: RENTAL EXPENSES NETTED AGAINST REVENUE PER TAX RETURN $19,170 FORM 990, SCH. D, PART XII, LINE 2D RECONCILIATION OF EXPENSES -------------------------- OTHER EXPENSES ON BOOKS BUT NOT ON RETURN: RENTAL EXPENSES NETTED AGAINST REVENUE PER TAX RETURN $19,170 SCH 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 true X true X 100 true true true false true true 602846 222837 380009 0.02460 2060519 1883133 177387 0.01150 2663365 2105970 557396 0.03610 40992 40992 0.00270 40992 40992 0.00270 2704357 2105970 598388 0.03880 7 6662 6662 0.00040 7 6662 6662 0.00040 true 1570888 6021600 6077487 -55887 X true true 1 1 TRIGG COUNTY HOSPITAL INC 254 MAIN STREET CADIZ KY 42211 X X X TRIGG COUNTY HOSPITAL INC 1 true X X X X X X X X X 13 true false true X http://trigghospital.org X X X X X X true false true true 100 true 100 true X X X X true true X X X X false false X X true X false false PART I, LINE 7 COST OF CHARITY CARE -------------------- COST OF CHARITY CARE WAS CALCULATED WTIH A COST TO CHARGE RATIO USING WORKSHEET 2. COST OF MEDICAID WAS CALCULATED WITH A COST TO CHARGE RATIO USING WORKSHEET 2. PART III, LINE 8 COSTING -------- TRIGG COUNTY HOSPITAL IS A CRITICAL ACCESS HOSPITAL AND IS REIMBURSED FROM MEDICARE AT 101% OF COST RELATED TO CARING FOR MEDICARE PATIENTS. MEDICARE REVENUES AND COSTS REPORTED ON LINES 5 AND 6 ARE BASED ON THE MEDICARE COST REPORT. PART III, LINE 9B DEBT COLLECTION --------------- THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE OR FINANCIAL ASSISTANCE. PART VI, LINE 2 NEEDS ASSESSMENT ---------------- TRIGG COUNTY HOSPITAL CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT WHICH WAS ADOPTED BY THE BOARD OF DIRECTORS ON APRIL 29, 2013. TRIGG COUNTY HOSPITAL IS ALWAYS WILLING AND AVAILABLE TO MEET THE NEEDS OF THE COMMUNITY AS THEY ARISE. ADDITIONALLY, TRIGG COUNTY HOSPITAL ASSISTS OTHER AGENCIES, AS NEEDED, TO MEET THE HEALTH AND WELFARE NEEDS OF THE COMMUNITY. PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE ----------------------------------------------- UNINSURED AND UNDERINSURED PATIENTS ARE PROVIDED WITH INFORMATION ABOUT THE CHARITY CARE PROGRAM. TRIGG COUNTY HOSPITAL CONTRACTS WITH DISABILITY MEDICAL CONSULTANTS (DMC) TO CONTACT EACH OF THESE IDENTIFIED PATIENTS AND PROVIDE THEM WITH INFORMATION ON HOW TO GET QUALIFIED FOR MEDICAID OR HOW TO ENROLL IN INSURANCE PROGRAMS AVAILABLE THROUGH THE AFFORDABLE CARE ACT. PART VI, LINE 4 COMMUNITY INFORMATION --------------------- TRIGG COUNTY, KENTUCKY IS A RURAL COMMUNITY WITH A POPULATION ESTIMATED AT 14,293. TRIGG COUNTY IS LOCATED IN WESTERN KENTUCKY JOINING THE LAND BETWEEN THE LAKES INCLUDING LAKE BARKLEY AND KENTUCKY LAKE. DUE TO OUR LOCATION, TRIGG COUNTY IS A GREAT RETIREMENT COMMUNITY AND AS SUCH APPEALS TO MANY PEOPLE ACROSS THE COUNTRY. APPROXIMATELY 20.5% OF TRIGG COUNTIANS ARE AGE 65 AND OLDER. TRIGG COUNTY HAS BEEN DESIGNATED AS A HEALTH PROFESSIONAL SHORTAGE AREA (HPSA) AND A MEDICALLY UNDERSERVED AREA/POPULATION (MUA/P). THE 2012 MEDIAN HOUSEHOLD INCOME IS RIGHT AT THE AVERAGE FOR KENTUCKIANS (APPROXIMATELY $40K); HOWEVER, WELL BELOW THE AVERAGE FOR THE UNITED STATES AT APPROXIMATELY $50K. TRIGG COUNTY'S ESTIMATED PREMATURE DEATH (LIFE LOST PRIOR TO AGE 75) IS 35% HIGHER THAN THE UNITED STATES AVERAGE AND 10% HIGHER THAN THE STATE AVERAGE, POTENTIALLY ATTRIBUTABLE TO A HIGHER NUMBER OF LUNG/BRONCHUS AND COLORECTAL CANCERS. FINALLY, APPROXIMATELY 18% OF TRIGG COUNTIANS HEALTH INSURANCE IS COVERED THROUGH KENTUCKY MEDICAID AND APPROXIMATELY 21% ARE UNINSURED. PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH ----------------------------- TRIGG COUNTY HOSPITAL'S DEDICATED STAFF VOLUNTEER FOR NUMEROUS CAUSES PROMOTING HEALTH AND WELFARE FOR TRIGG COUNTIANS INCLUDING: RELAY FOR LIFE, BREAST IMAGING LUNCH & LEARN, HEART HEALTH LUNCH & LEARN, BREAST IMAGING PRESENTATIONS, KIDS HEALTH FAIR, BREAST CANCER AWARENESS EVENTS, OSTEOPOROSIS SCREENINGS, BACK TO SCHOOL SCREENINGS AND BEHAVIORAL HEALTH TRANSPORTATION. ADDITIONALLY, HOSPITAL STAFF ARE INVOLVED IN SUMMER HEALTH CAMP, COMMUNITY READER DAYS, CHILDREN'S CHRISTMAS TREE DECORATING, TEACHERS BACK TO SCHOOL BREAKFAST, MEET & GREET TEACHERS & PARENTS NIGHT, COMMUNITY EDUCATION ADVISORY COUNCIL, BETA NU AND THE TRIGG COUNTY CHAMBER OF COMMERCE. TRIGG COUNTY HOSPITAL'S BOARD OF DIRECTORS IS COMPRISED OF COMMUNITY VOLUNTEERS WHO ARE COMMITTED TO THE HEALTH AND WELFARE OF THE COMMUNITY AND DEDICATED TO ENSURING THE VIABILITY OF THE HOSPITAL FOR YEARS TO COME. THE BOARD EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE SERVICE AREA. THE HOSPITAL OPERATES AN EMERGENCY DEPARTMENT THAT IS STAFFED 24 HOURS A DAY/7 DAYS A WEEK AND SERVES EVERYONE REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL RESEARCHES AND COMPLETES NUMEROUS GRANT APPLICATIONS APPLICABLE TO PROMOTING THE HEALTH OF OUR COMMUNITY. PART V, LINE 20 AMOUNTS CHARGED TO FAP-ELIGIBLE INDIVIDUALS ------------------------------------------- PATIENTS QUALIFYING FOR DSH HAVE THEIR STAY WRITTEN OFF. THOSE THAT DO NOT ARE CHARGED FOR THE CARE AND HAVE THE OPTION TO SET UP A PAYMENT PLAN IF NEEDED. PART V, LINE 3 CHNA COMMUNITY INPUT -------------------- TRIGG COUNTY SENT A CHNA SURVEY OUT TO THE LOCAL POPULATION FOR ANY RESIDENT TO COMPLETE. 135 RESPONSES TO THIS SURVEY WERE RECEIVED FROM AREA RESIDENTS. IN ADDITION, CONSULTATION WITH 34 LOCAL EXPERTS OCCURRED VIA AN INTERNET BASED SURVEY DURING A PERIOD BEGINNING JANUARY 20, 2013 AND ENDING JANUARY 31, 2013. INFORMATION RELATED TO THE EXPERTS' INPUT IS INCLUDED IN THE CHNA AT http://trigghospital.org/docs/TRIGG-HOSPITAL-CHNA-REPORT-4-29-13.pdf?child =Community+Health+Needs+Assessment PART V, LINE 7 CHNA NEEDS ADDRESSED -------------------- TRIGG COUNTY IDENTIFIED THE NEEDS OF THE COMMUNITY AS EITHER LOW PRIORITY OR HIGH PRIORITY AND DETERMINED THAT THE BEST USE OF TRIGG COUNTY HOSPITAL'S RESOURCES IS TO FOCUS ON RESOLVING OR IMPROVING HIGHER PRIORITY NEEDS RATHER THAN ATTEMPTING TO RESPOND TO EVERYTHING WITH SMALL, PERHAPS INEFFECTIVE, EFFORTS. PART V IMPLEMENTATION STRATEGY ----------------------- THE IMPLEMENTATION STRATEGY IS AVAILABLE AT http://trigghospital.org/docs/TRIGG-HOSPITAL-CHNA-REPORT-4-29-13.pdf?child =Community+Health+Needs+Assessment X X false false false false false false false false false ALISA B COLEMAN CEO 145624 0 35604 0 0 0 5650 0 7101 0 193979 0 0 0 CLIFFORD POPPENS PHYSICIAN 186489 0 26933 0 0 0 5612 0 0 0 219034 0 0 0 JAMES BRAZIL PHYSICIAN 198892 0 24244 0 0 0 6383 0 0 0 229519 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B REVIEW OF FORM 990 ------------------ A COPY OF THE FORM 990 WILL BE PROVIDED TO THE BOARD VIA EMAIL BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C MONITORING OF THE CONFLICT OF INTEREST POLICY --------------------------------------------- THE CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY. ALL EMPLOYEES, STAFF, OFFICERS AND BOARD MEMBERS ARE COVERED BY THIS POLICY. EACH YEAR, THE BOARD MEMBERS ARE ASKED TO SIGN A CONFLICT OF INTEREST STATEMENT. THE HOSPITAL HAS POLICIES AND PROCEDURES IN PLACE THAT WILL BE FOLLOWED SHOULD A CONFLICT OF INTEREST ARISE. A RECORD OF THE PROCEEDINGS WHERE CONFLICTS ARE ADDRESSED IS KEPT ON FILE ONCE REVIEWED. FORM 990, PART VI, SECTION C, LINE 19 MAKING DOCUMENTS AVAILABLE TO THE PUBLIC ---------------------------------------- A LEGAL AD IS PUBLISHED ANNUALLY TO ADVISE OF THE AVAILABILITY OF AUDITED FINANCIAL STATEMENTS AT THE HOSPITAL. FORM 990, PART VI, SECTION B, LINE 15A & 15B PROCESS FOR DETERMINING COMPENSATION ------------------------------------ THE HOSPITAL BOARD CONSULTS ITS MANAGEMENT ADVISORY FIRM FOR PAY RANGES FOR ITS CEO BASED ON A CEO NATIONAL SALARY SURVEY. THE CEO OF THE HOSPITAL'S SALARY FALLS BETWEEN THE MINIMUM POINT AND MAXIMUM POINT OF THE SURVEY RESULTS. THE HOSPITAL USES SALARY DATA FROM THE KENTUCKY HOSPITAL ASSOCIATION TO DECIDE COMPENSATION AMOUNTS FOR OFFICERS AND OTHER KEY EMPLOYEES. THE HOSPITAL'S ADMINISTRATION APPROVES THE SALARIES. FORM 990, PART IX, LINE 11G FUNCTIONAL EXPENSES BREAKOUT ---------------------------- THE FOLLOWING IS BREAKOUT OF TOTAL OTHER FEES FOR SERVICES OF $2,564,957: MEDICAL PURCHASED SERVICES (PROGRAM) $2,335,679 ADMIN PURCHASED SERVICES (PROGRAM) 183,977 ADMIN PURCHASED SERVICES (MGMT & GEN) 45,301 ----------- $2,564,957 TRIGG COUNTY HOSPITAL FOUNDATION INC 254 MAIN STREET CADIZ KY 42211 061805018 EDUCATION KY 501(c)(3) 7 NA false TRIGG COUNTY PUBLIC HOSPITAL CORPORATION PO BOX 672 CADIZ KY 42211 611336530 GOV UNIT KY 501(a) N/A NA false false false false false false false false false false false false false false false false false false false false