2014-03-14T12:16:11-05:00 2013-04-30 BKD LLP 400 E MAIN ST STE 200 PO BOX 1196 BOWLING GREEN KY 421021196 990 2012-05-01 610471581 TRIGG COUNTY HOSPITAL INC % ALISA COLEMAN TRIG 2705223215 254 MAIN ST Suite CADIZ KY 42211 Alisa B Coleman 2705222525 2014-03-14 true 2707810111 2012 2015-11-30 17:44:51Z ALISA B COLEMAN CEO 254 MAIN STREET CADIZ KY 42211 14259048 false X WWW.TRIGGHOSPITAL.ORG X 1952 KY 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. 12 12 195 83 0 0 788662 694120 11788787 13029022 4816 3792 328791 529674 12911056 14256608 0 0 0 0 7012579 7456720 0 0 0 5313203 6068247 12325782 13524967 585274 731641 6126067 8084280 4322021 5548593 1804046 2535687 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 12137250 13036098 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. 12137250 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 45 0 true 195 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 ALISA COLEMAN 2705223215 254 MAIN STREET CADIZ KY 42211 DR MICHAEL GROSS 1.0 X X 0 0 0 GEORGE RADFORD 1.0 X X 0 0 0 STEPHANIE PERRY 1.0 X 0 0 0 DAN JERGENS 1.0 X 0 0 0 BOB CASSITY 1.0 X 0 0 0 BOB NOEL 1.0 X 0 0 0 BEN CUNDIFF 1.0 X 0 0 0 MALLORY LAWRENCE 1.0 X 0 0 0 SHEA GODWIN MD 1.0 X 14518 0 0 MARC TERRELL 1.0 X 0 0 0 ERIC BLEIDT 1.0 X 0 0 0 JESSE THOMAS 1.0 X X 0 0 0 ALISA B COLEMAN 40.0 X 141920 0 7031 DIANA PHILLIPS 40.0 X 59184 0 884 CLIFFORD POPPENS 36.0 X 188600 0 5658 DAVID RUTLAND 40.0 X 129013 0 11825 HOLLY MCCORMICK 40.0 X 103767 0 5032 JAMES BRAZIL 30.0 X 210500 0 1109 847502 0 31539 5 false true false BLUEGRASS PHYSICIANS ECI PO BOX 674579 DETROIT MI 482674579 ER PHYSICIANS 1542225 DIAMOND HEALTHCARE GROUP PO BOX 85050 RICHMOND VA 23285 BEHAVORIAL HEALTH 247983 CPSI 6600 WALL STREET MOBILE AL 36695 BILLING 291796 QUORUM HEALTH RESOURCES 105 CONTINENTAL PLACE BRENTWOOD TN 370271018 MANAGEMENT SERVICES 219888 SYSTEM SOLUTIONS 115 CARLISLE COURT PADUCAH KY 42001 IT EQUPIMENT SUPPORT 232682 8 694120 694120 Net Patient Service Revenue 621110 13029022 13029022 13029022 3792 3792 0 0 28033 2440 25593 0 25593 25593 0 0 0 0 LIFE LINE 900099 7076 7076 EHR INCENTIVES 900099 431466 431466 Cafeteria 722210 33779 33779 31760 31760 504081 14256608 13036098 526390 0 0 0 0 0 223536 14518 209018 5911330 5608699 302631 98350 90128 8222 788274 722376 65898 435230 398846 36384 177123 177123 58946 58946 0 2282 2282 0 0 2692868 2593076 99792 53440 52605 835 528946 507928 21018 0 0 403497 392935 10562 51530 33711 17819 0 0 121526 121526 0 534225 534225 185886 185886 Medical Supplies 536299 528221 8078 Accounting Collections 163428 781 162647 Maintenance & Repair 309378 308179 1199 Provider Tax 120870 120870 128003 106344 21659 13524967 12137250 1387717 0 564828 486494 207160 141184 0 0 1668224 2331687 0 0 0 0 115203 74291 98821 106039 114802 142235 10776969 5977138 3354510 4799831 0 0 0 0 0 0 0 0 2519 2519 6126067 8084280 1664126 2390018 0 0 31009 0 0 0 0 0 0 0 2195615 2895148 0 0 431271 263427 4322021 5548593 X 403814 283410 1400232 2252277 0 0 1804046 2535687 6126067 8084280 731641 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 2282 2282 false false LOBBYING EXPENSES SCH. C, PART II-B, LINE I A PORTION OF THE ORGANIZATION'S KHA & AHA DUES ARE USED FOR LOBBYING ACTIVITIES. 66000 66000 5668039 2508733 3159306 5042930 3468405 1574525 4799831 0 DUE TO THIRD PARTY PAYERS 263427 263427 14259048 2440 2440 14256608 14256608 13527407 2440 2440 13524967 13524967 RECONCILIATION OF REVENUE PER AUDITED FINANCIAL STATEMENTS WITH FORM 990 FORM 990, SCH. D, PART XII ------------------ OTHER REVENUE ON BOOKS BUT NOT ON RETURN: RENTAL EXPENSES NETTED AGAINST REVENUE PER TAX RETURN $2,440 RECONCILIATION OF EXPENSES PER AUDITED FINANCIAL STATEMENTS WITH FORM 990 FORM 990, SCH. D, PART XIII ------------------ OTHER EXPENSES ON BOOKS BUT NOT ON RETURN: RENTAL EXPENSES NETTED AGAINST REVENUE PER TAX RETURN $2,440 INCOME TAXES SCH D, PART X, LINE 2 ------------------ THE HOSPITAL HAS BEEN RECOGNIZED AS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND A SIMILAR PROVISION OF STATE LAW. HOWEVER, THE HOSPITAL IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. true true true X true X 100 true true true false true true 650959 176613 474346 0.03510 1625577 1515421 110156 0.00810 2276536 1692034 584502 0.04320 28944 28944 0.00210 28944 28944 0.00210 2305480 1692034 613446 0.04530 7 6318 6318 0.00050 7 6318 6318 0.00050 true 1359533 6271780 6063508 208272 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 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 COST OF CHARITY CARE PART I, LINE 7 ---------------- 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. COSTING PART III, LINE 8 ---------------- 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. DEBT COLLECTION PART III, LINE 9B ---------------- THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE OR FINANCIAL ASSISTANCE. NEEDS ASSESSMENT PART VI, LINE 2 ---------------- 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. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI, LINE 3 ---------------- 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. COMMUNITY INFORMATION PART VI, LINE 4 ---------------- TRIGG COUNTY, KENTUCKY IS A RURAL COMMUNITY WITH A POPULATION ESTIMATED AT 13,659. 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% 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 TWICE THE UNITED STATES AVERAGE AND 67% HIGHER THAN THE STATE AVERAGE, POTENTIALLY ATTRIBUTABLE TO A HIGHER NUMBER OF LUNG/BRONCHUS AND COLORECTAL CANCERS. FINALLY, APPROXIMATELY 20% OF TRIGG COUNTIANS HEALTH INSURANCE IS COVERED THROUGH KENTUCKY MEDICAID AND APPROXIMATELY 21% ARE UNINSURED. PROMOTION OF COMMUNITY HEALTH PART VI, LINE 5 ---------------- 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, BREAST IMAGING PRESENTATIONS, STROKE FAIR, KIDS HEALTH FAIR, BREAST CANCER AWARENESS EVENTS, OSTEOPOROSIS SCREENINGS, IMAGING SERVICES - ASK THE EXPERT, PROSTATE CANCER SCREENING, BACK TO SCHOOL SCREENINGS, SKIN CARE SCREENINGS AND BEHAVIORAL HEALTH TRANSPORTATION. ADDITIONALLY, HOSPITAL STAFF ARE INVOLVED IN COMMUNITY READER DAYS, 4-H REALITY STORE, 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. AMOUNTS CHARGED TO FAP-ELIGIBLE INDIVIDUALS PART V, SECTION B, LINE 19 ---------------- 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. CHNA COMMUNITY INPUT PART V, LINE 3 -------------------- 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 CHNA NEEDS ADDRESSED PART V, LINE 7 -------------------- 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. IMPLEMENTATION STRATEGY PART V -------------------- 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 CLIFFORD POPPENS 188600 0 0 0 0 0 5658 0 0 0 194258 0 0 0 JAMES BRAZIL 188000 0 22500 0 0 0 1109 0 0 0 211609 0 0 0 REVIEW OF FORM 990 FORM 990, PART VI, SECTION B, LINE 11 ------------------ A COPY OF THE FORM 990 WILL BE PROVIDED TO THE BOARD VIA EMAIL BEFORE FILING. MONITORING OF THE CONFLICT OF INTEREST POLICY FORM 990, PART VI, SECTION B, LINE 12C ------------------ THE CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY. ALL EMPLOYEES, STAFF, OFFICERS AND BOARD MEMBERS ARE COVERED BY THIS POLICY. A RECORD OF THE PROCEEDINGS WHERE CONFLICTS ARE ADDRESSED IS KEPT ON FILE ONCE REVIEWED. MAKING DOCUMENTS AVAILABLE TO THE PUBLIC FORM 990, PART VI, SECTION C, LINE 19 ------------------ A LEGAL AD IS PUBLISHED ANNUALLY TO ADVISE OF THE AVAILABILITY OF AUDITED FINANCIAL STATEMENTS AT THE HOSPITAL. PROCESS FOR DETERMINING COMPENSATION FORM 990, PART VI, SECTION B, LINE 15A & 15B ------------------ 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. 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(C)(3) 6 NA false false false false false false false false false false false false false false false false false false false