THE COMMUNITY HOSPITAL INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
THE COMMUNITY HOSPITAL INC (EIN 61-0445841)
Tax period
2012-10-01 to 2013-09-30
Filed
2014-06-03
IRS object ID
201441549349300604
Schema version
2012v2.3
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

FieldValueIRS element (for citing)
Timestamp2014-06-03T08:27:44-05:00Timestamp
Tax Period End Date2013-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1KERBER ECK & BRAECKEL LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line11116 W MAIN STAddressLine1
CityCARBONDALECity
StateILState
ZIP Code629012335ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN610445841EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1MUHLENBERG COMMUNITY HOSPITAL INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMUHLNameControl
Phone2703388000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1440 HOPKINSVILLE STAddressLine1
CityGREENVILLECity
StateKYState
ZIP Code423451124ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameC RENEE' ORANGEName
TitleCFOTitle
Phone2703388000Phone
Date Signed2014-05-30DateSigned
Authorize Third PartyfalseAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameMARK DALLASName
Phone6185291040Phone
Date Prepared2014-06-03DatePrepared
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonED HEATHNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1440 HOPKINSVILLE STAddressLine1
CityGREENVILLECity
StateKYState
ZIP Code42345ZIPCode
FieldValueIRS element (for citing)
Gross Receipts31234415GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.MCHKY.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1938YearFormation
State Legal DomicileKYStateLegalDomicile
Activity Or Mission DescriptionTHE MISSION OF MUHLENBERG COMMUNITY HOSPITAL IS TO PROVIDE LOCAL ACCESS TO A FULL SERVICE HEALTH SYSTEM THROUGH THE EFFICIENT DELIVERY OF QUALITY SERVICES.ActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees531TotalNbrEmployees
Total Nbr Volunteers30TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year462399ContributionsGrantsPriorYear
Contributions Grants Current Year607533ContributionsGrantsCurrentYear
Program Service Revenue Prior Year32843901ProgramServiceRevenuePriorYear
Program Service Revenue CY30312783ProgramServiceRevenueCY
Investment Income Prior Year422338InvestmentIncomePriorYear
Investment Income Current Year90296InvestmentIncomeCurrentYear
Other Revenue Prior Year190573OtherRevenuePriorYear
Other Revenue Current Year164819OtherRevenueCurrentYear
Total Revenue Prior Year33919211TotalRevenuePriorYear
Total Revenue Current Year31175431TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year20148971SalariesEtcPriorYear
Salaries Etc Current Year18786573SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year15332177OtherExpensePriorYear
Other Expenses Current Year14851327OtherExpensesCurrentYear
Total Expenses Prior Year35481148TotalExpensesPriorYear
Total Expenses Current Year33637900TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-1561937RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-2462469RevenuesLessExpensesCY
Total Assets BOY20734954TotalAssetsBOY
Total Assets EOY18451181TotalAssetsEOY
Total Liabilities BOY3835595TotalLiabilitiesBOY
Total Liabilities EOY4015713TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY16899359NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY14435468NetAssetsOrFundBalancesEOY
Mission DescriptionTHE MISSION OF MUHLENBERG COMMUNITY HOSPITAL IS TO PROVIDE LOCAL ACCESS TO A FULL SERVICE HEALTH SYSTEM THROUGH THE EFFICIENT DELIVERY OF QUALITY SERVICES.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense33637900Expense
Revenue30339520Revenue
DescriptionHEALTH CARE DELIVERY & MANAGEMENT: THE HOSPITAL OPERATES A 90 BED ACUTE CARE AND A 45 BED SKILLED NURSING FACILITY WITH RELATED OUTPATIENT AND ANCILLARY SERVICES, INCLUDING A 24 HOUR EMERGENCY DEPARTMENT. MUHLENBERG COMMUNITY HOSPITAL (MCH) PARTICIPATES WITH MEDICARE, MEDICAID AND INDIGENT CARE PROGRAMS IN THE STATE OF KENTUCKY. THE HOSPITAL PROMOTES AND FURTHERS THE HEALTH AND GENERAL STANDARDS OF LIVING IN OUR COMMUNITY. THE ACTIVITY OF RENDERING HEALTH SERVICES TO ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY, ACCOMPLISHES THE HOSPITAL'S EXEMPT PURPOSE.Description
Total Program Service Expense33637900TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationtrueBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshptrueOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntitytrueDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109660NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees531NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business RelationshiptrueFamilyOrBusinessRelationship
Delegation Of Management DutiestrueDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1JOE SWABBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number2703388277TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1440 HOPKINSVILLE STAddressLine1
CityGREENVILLECity
StateKYState
ZIP Code42345ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (20 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
CHARLES R LEWIS
CHAIRMAN2.00X000
DAVID JERNIGAN
VICE CHAIRMA2.00X000
W LEE FAUNTLEROY
SECRETARY/TR2.00X000
TAMMY S BREWER
IMMEDIATE PA2.00X000
DR MARY WEBB BROWN
BOARD MEMBER2.00X000
LANIE WEBB GARDNER
BOARD MEMBER2.00X000
TODD STILES
MEDICAL STAF2.00X000
DR WILLARD KEITH
BOARD MEMBER2.00X000
DR FREDDIE MAYES
BOARD MEMBER2.00X000
DR JAMES K KOPER
BOARD MEMBER2.00X000
MARK POGUE
BOARD MEMBER2.00X000
DR AD POLLOCK JR
BOARD MEMBER2.00X000
KATHLEEN MITCHELL
CNO40.0011967000X
JOHN COUNTZLER
CEO40.00000X
JOSEPH SWAB
CFO40.00000X
DR VINCENT GENOVESE
PHYSICIAN40.0040000500X
DR TERRY HOLT
PHYSICIAN40.0022499400X
DR SHANE NAPIER
PHYSICIAN40.0020046200X
LAURA STILES
RPH40.0011354700X
ANN C MURPHY
RPH40.0011193600X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1170614TotalReportableCompFromOrg
Number Individuals GT100 K6NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcestrueCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
ALLIANT MANAGEMENT SERVICES
2650 EASTPOINTE PKWY SUITE 310LOUISVILLEKY40223MANAGEMENT SERV537100
KY EMERGENCY ROOM PHYSICIAN
320 DAWN DRIVEGREENVILLEKY42345ER PHYS/HOSPITA491049
SODEXHO
9801 WASHINGTON BLVDGAITHERSBERGMD20878DIETERYSRVCMGMT141128
LOGANS HEALTHCARE
1240 HARRY LONG ROADSHELBYVILLEKY40065LINEN SERVICES127997
QUEST DIAGNOSTICS
PO BOX 101071ATLANTAGA30374LABORATORY SERV121217
FieldValueIRS element (for citing)
Number Of Contractors GT100 K6NumberOfContractorsGT100K
Government Grants542533GovernmentGrants
All Other Contributions65000AllOtherContributions
Total Contributions607533TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionNET PATIENT SERVICE REVENUEDescription
Total Revenue Column30312783TotalRevenueColumn
Related Or Exempt Function Income30312783RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue30312783TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column63559TotalRevenueColumn
Exclusion$63,559ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real29175Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real29175Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column29175TotalRevenueColumn
Exclusion$29,175ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other85721Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other58984Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other26737Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column26737TotalRevenueColumn
Related Or Exempt Function Income26737RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
DIETARY / CAFETERIA112115$112,115
MISCELLANEOUS23529$23,529
FieldValueIRS element (for citing)
Total Other Revenue135644TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column31175431TotalRevenueColumn
Related Or Exempt Function Income30339520RelatedOrExemptFunctionIncome
Exclusion$228,378ExclusionAmount
FieldValueIRS element (for citing)
Info In Schedule O Part IXXInfoInScheduleOPartIX

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total119670Total
Program Services119670ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total14456467Total
Program Services14456467ProgramServices

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total3054755Total
Program Services3054755ProgramServices

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1155681Total
Program Services1155681ProgramServices

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total539923Total
Program Services539923ProgramServices

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total82153Total
Program Services82153ProgramServices

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total41568Total
Program Services41568ProgramServices

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total3478787Total
Program Services3478787ProgramServices

Advertising Advertising

FieldValueIRS element (for citing)
Total249352Total
Program Services249352ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total581129Total
Program Services581129ProgramServices

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total160052Total
Program Services160052ProgramServices

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1847317Total
Program Services1847317ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total129679Total
Program Services129679ProgramServices

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total58413Total
Program Services58413ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total49113Total
Program Services49113ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1428552Total
Program Services1428552ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total523603Total
Program Services523603ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
MEDICAL SUPPLIES & DRUGS46325534632553
PROVIDER & OTHER TAXES866511866511
MEMBERSHIPS & SUBSCRIPTIO126273126273
MISCELLANEOUS5634956349

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total33637900Total
Program Services33637900ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY717399BOY
EOY124101EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY430037BOY
EOY437883EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY6840313BOY
EOY6306109EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1179243BOY
EOY1142745EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY558592BOY
EOY157888EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis40970924LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec32896569LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY8341564BOY
EOY8074355EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY1187132BOY
EOY536455EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY1122721BOY
EOY1122721EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY357953BOY
EOY548924EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY20734954BOY
EOY18451181EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY2749204BOY
EOY2936710EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY874244BOY
EOY781773EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY212147BOY
EOY297230EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY3835595BOY
EOY4015713EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY16899359BOY
EOY14435468EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY16899359BOY
EOY14435468EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY20734954BOY
EOY18451181EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-2462469ReconcilationRevenueExpenses
Reconciliation Unrealized Invest-1422ReconciliationUnrealizedInvest
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedtrueFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis208485OtherCostOrOtherBasis
Book Value208485BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis11557505OtherCostOrOtherBasis
Depreciation8951591Depreciation
Book Value2605914BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis27640358OtherCostOrOtherBasis
Depreciation23514359Depreciation
Book Value4125999BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1564576OtherCostOrOtherBasis
Depreciation430619Depreciation
Book Value1133957BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings8074355TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
DUE TO THIRD-PARTY PAYORS$245,230
MCH FOUNDATION - NOTE PAYABLE$52,000
FieldValueIRS element (for citing)
Total Of Amounts297230TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

FieldValueIRS element (for citing)
IdentifierLIABILITY UNDER FIN 48 FOOTNOTEIdentifier
Return ReferenceSCHEDULE D, PAGE 3, PART XReturnReference
ExplanationMUHLENBERG COMMUNITY HOSPITAL IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. MANAGEMENT IS NOT AWARE OF ANY ACTIVITY WITHIN THE HOSPITAL DURING THE CURRENT OR PRIOR REPORTING PERIODS THAT WOULD JEOPARDIZE OR OTHERWISE CALL INTO QUESTION THE HOSPITAL'S COMPLIANCE WITH THE ABOVE INTERNAL REVENUE CODE SECTION.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted CarefalseFPGReferenceDiscountedCare
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgettrueExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense1165778TotalCommunityBenefitExpense
Net Community Benefit Expense1165778NetCommunityBenefitExpense
Percent Of Total Expense0.03470PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense6727077TotalCommunityBenefitExpense
Direct Offsetting Revenue4360851DirectOffsettingRevenue
Net Community Benefit Expense2366226NetCommunityBenefitExpense
Percent Of Total Expense0.07030PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense7892855TotalCommunityBenefitExpense
Direct Offsetting Revenue4360851DirectOffsettingRevenue
Net Community Benefit Expense3532004NetCommunityBenefitExpense
Percent Of Total Expense0.10500PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense97031TotalCommunityBenefitExpense
Net Community Benefit Expense97031NetCommunityBenefitExpense
Percent Of Total Expense0.00290PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense97031TotalCommunityBenefitExpense
Net Community Benefit Expense97031NetCommunityBenefitExpense
Percent Of Total Expense0.00290PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense7989886TotalCommunityBenefitExpense
Direct Offsetting Revenue4360851DirectOffsettingRevenue
Net Community Benefit Expense3629035NetCommunityBenefitExpense
Percent Of Total Expense0.10790PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$1,553,462BadDebtExpenseAmount
Amount Attributable To776731AmountAttributableTo
Amount Reimbursed By Medicare11853927AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare14163769CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-2309842MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1MUHLENBERG COMMUNITY HOSPITAL INCBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1440 HOPKINSVILLE STAddressLine1
CityGREENVILLECity
StateKYState
ZIP Code423450387ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours
OtherHOME HEALTH-EMS-SKILLED NURSINOther

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1MUHLENBERG COMMUNITY HOSPITAL INCBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
CHNA ConductedtrueCHNAConducted
Community DefinitionXCommunityDefinition
Community DemographicsXCommunityDemographics
How Data ObtainedXHowDataObtained
Community Health NeedsXCommunityHealthNeeds
Identifying ProcessXIdentifyingProcess
Consulting ProcessXConsultingProcess
Needs Assessment Conducted13NeedsAssessmentConducted
Take Into AccounttrueTakeIntoAccount
Other FacilitiesfalseOtherFacilities
CHNA Widely AvailabletrueCHNAWidelyAvailable
Own WebsiteXOwnWebsite
On RequestXOnRequest
Adopt Implement StrategyXAdoptImplementStrategy
Execute Implement StrategyXExecuteImplementStrategy
Other Needs AddressedXOtherNeedsAddressed
All Needs AddressedfalseAllNeedsAddressed
Organization Incur Excise TaxfalseOrganizationIncurExciseTax
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreetrueUsesFPGFree
FPG Free Percent200.0FPGFreePercent
Uses FPG DiscountedfalseUsesFPGDiscounted
Explains BasistrueExplainsBasis
Income LevelXIncomeLevel
Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Other PublicityXOtherPublicity
Actions On NonpaymenttrueActionsOnNonpayment
Permit Report To Credit AgencyXPermitReportToCreditAgency
Permit LawsuitXPermitLawsuit
Collection ActivitiestrueCollectionActivities
Report To Credit AgencyXReportToCreditAgency
LawsuitXLawsuit
Notify Upon AdmissionXNotifyUponAdmission
Notify Before DischargeXNotifyBeforeDischarge
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargesfalseGrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities3NumberOfOtherFacilities

Other Facilities OtherFacilities (3 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
HOME HEALTH SERVICES
440 HOPKINSVILLE STREETGREENVILLEKY42345HOME HEALTH
MUHLENBERG SURGICAL CENTER
1008 MEDICAL CENTER DRIVEPOWDERLYKY42367SURGERY CENTER
CENTRAL CITY FAMILY CLINIC
101 LEGION DRCENTRAL CITYKY42330PHYSICAN CLINIC

Form990 Schedule H Part VI Form990ScheduleHPartVI (15 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
COSTING METHODOLOGY EXPLANATIONPART I LINE 7A RATIO OF PATIENT CARE COSTTOCHARGES AS CALCULATED FROM WORKSHEET 2 OF THE 2012 990 SCHEDULE H INSTRUCTIONS WAS USED TO DETERMINE THE AMOUNTS ON LINES 7A AND 7B OF PART I
COMMUNITY BUILDING ACTIVITIESPART IIMUHLENBERG COMMUNITY HOSPITAL HAS AN ONGOING COMMITMENT TO ITS COMMUNITY DUE TO MUHLENBERG COUNTYS HIGH RATE OF JOBLESSNESS THE HOSPITAL DECIDED IT WAS IN THE COMMUNITYS BEST INTEREST TO SUPPORT LOCAL VENDORS WHEN POSSIBLE AND TO SUPPORT COMMUNITY EFFORTS TO BRING NEW INDUSTRY TO THE REGION THE HOSPITAL ALSO SUPPORTS LOCAL DISASTER PREPAREDNESS ACTIVITIES
BAD DEBT EXPENSE EXPLANATIONPART III LINE 4THE TOTAL BAD DEBT EXPENSE AT COST REPRESENTS THE TOTAL AMOUNT EXPECTED TO BE COLLECTED BUT DEEMED UNCOLLECTIBLE BASED ON THE COMMUNITYS DEMOGRAPHICS INCOME LEVEL INDIVIDUAL ASSETS AND HEALTH COVERAGE 50 WAS DETERMINED TO BE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE HOSPITALS PATIENT FINANCIAL ASSISTANCE PROGRAM PATIENTS ARE SCREENED FOR DSH AND CHARITY BASED ON APPLICATIONS THE ONES WHO DO NOT QUALIFY BECOME BAD DEBT ACCOUNTS FINANCIAL STATEMENT FOOTNOTE PATIENT ACCOUNTS RECEIVABLE ARE ORDINARILY DUE THIRTY DAYS AFTER THE ISSUANCE OF THE INVOICE AT THE EXPIRATION OF THE THIRTY DAYS IF NO RESPONSE IS RECEIVED FROM THE PATIENT A STATEMENT IS GENERATED AND FORWARDED TO AN OUTSOURCE AGENCY HEALTH CLAIMS MANAGEMENT HCM HCM WILL GENERATE AND PROCESS A TOTAL OF THREE STATEMENTS TO COLLECT THE AMOUNT DUE ADDITIONAL STATEMENTS COULD BE GENERATED IF A PAYMENT ARRANGEMENT HAS BEN APPROVED IF THE HOSPITAL RECEIVES NO PAYMENT OR COMMUNICATION TO ARRANGE PAYMENT THE ACCOUNT IS SENT TO COLLECTIONS AND RECOGNIZED AS BAD DEBT AT THAT TIME
MEDICARE EXPLANATIONPART III LINE 8THE TOTAL MEDICARE ALLOWABLE COSTS OF CARE REPRESENTS THE AMOUNT REPORTED IN THE HOSPITALS MEDICARE COST REPORT MUHLENBERG COMMUNITY HOSPITALS MEDICARE SHORTFALL SHOULD BE CONSIDERED COMMUNITY BENEFIT DUE TO THE COMMUNITY IT SERVES MEDICARE REPRESENTS 43 OF THE HOSPITALS PAYOR MIX WITH MEDICARE REPRESENTING SUCH A LARGE PORTION OF THE PAYOR MIX THE HOSPITAL DEPENDS ON MEDICARE PAYMENTS IF MEDICARE PAYS LESS THAN COST IT IS DETRIMENTAL TO THE HOSPITAL AND THEREFORE SHOULD BE CONSIDERED AS COMMUNITY BENEFIT
COLLECTION PRACTICES EXPLANATIONPART III LINE 9BPATIENT ACCOUNTS THAT ARE APPROVED FOR CHARITY ARE WRITTEN OFF TO OUR HOSPITAL CHARITY ADJUSTMENT THE PATIENT IS NOTIFIED OF CHARITY APPROVAL BY MAIL NO FURTHER STATEMENTS OF ACCOUNT OR OTHER CORRESPONDENCE ARE ISSUED
NEEDS ASSESSMENTPART VIMUHLENBERG COMMUNITY HOSPITAL ASSESSES THE COMMUNITYS HEALTH CARE NEEDS BY OBTAINING INFORMATION FROM A VARIETY OF SOURCES INCLUDING A DEMOGRAPHIC DATABASES B LOCAL AND REGIONAL HEALTH DEPARTMENTS AND RELATED DATABASES C KENTUCKY HOSPITAL ASSOCIATION REPORTS AND DATABASES D MARKET ANALYSIS E FEEDBACK FROM PHYSICIANS AND OTHER INTERESTED COMMUNITY GROUPS F HOSPITALGENERATED REPORTS ON UTILIZATION OF SERVICES G BOARD OF DIRECTORS MADE UP OF LOCAL COUNTY RESIDENTS IN 2013 A COMMUNITY HEALTH NEEDS ASSESSMENT CHNA IMPLEMENTATION STRATEGY WAS PREPARED FOR MUHLENBERG COMMUNITY HOSPITAL BY THE COMMUNITY AND ECONOMIC DEVELOPMENT INITIATIVE OF KENTUCKY CEDIK AT THE UNIVERSITY OF KENTUCKY THE ASSESSMENT PROCESS INCLUDED COLLECTING SECONDARY DATA RELATED TO THE HEALTH OF THE COMMUNITY SOCIAL AND ECONOMIC DATA AS WELL AS HEALTH OUTCOMES DATA WERE COLLECTED FROM SECONDARY SOURCES TO HELP PROVIDE CONTEXT FOR THE COMMUNITYCEDIK COMPILED HOSPITAL UTILIZATION DATA TO BETTER UNDERSTAND WHO WAS USING THE FACILITY AND FOR WHAT SERVICES INPUT FROM THE COMMUNITY WAS COLLECTED THROUGH FOCUS GROUP DISCUSSIONS AND SURVEYS THREE FOCUS GROUPS WERE CONDUCTED THROUGHOUT THE COMMUNITY AND IN CONJUNCTION WITH OTHER MEETINGS THE SENIOR POPULATION AND THE UNDERSERVED WERE TARGETED AND PARTICIPATED IN A FOCUS GROUP WHILE TWO OTHER FOCUS GROUPS TOOK PLACE WITH THE STEERING COMMITTEE AND THE ECONOMIC DEVELOPMENT COMMUNITY TO FACILITATE PRIORITIZATION OF IDENTIFIED HEALTH NEEDS A RANKING PROCESS WAS USED HEALTH NEEDS WERE RANKED BASED ON FIVE FACTORS 1 THE ABILITY OF MUHLENBERG COMMUNITY HOSPITAL TO EVALUATE AND MEASURE OUTCOMES 2 THE NUMBER OF PEOPLE AFF ECTED BY THE ISSUE OR SIZE OF THE ISSUE 3 THE CONSEQUENCES OF NOT ADDRESSING THIS PROBLEM 4 PREVALENCE OF COMMON THEMES 5 THE EXISTENCE OF HOSPITAL PROGRAMS WHICH RESPOND TO THE IDENTIFIED NEED HEALTH NEEDS WERE THEN PRIORITIZED TAKING INTO ACCOUNT THEIR OVERALL RANKING THE DEGREE TO WHICH MUHLENBERG COMMUNITY HOSPITAL CAN INFLUENCE LONGTERM CHANGE AND THE IMPACT OF THE IDENTIFIED HEALTH NEEDS ON OVERALL HEALTH MUHLENBERG COMMUNITY HOSPITAL WILL CONTINUE TO WORK WITH THE COMMUNITY TO EXECUTE THE IMPLEMENTATION PLAN AND REALIZE THE GOALS THAT HAVE BEEN POSITIONED TO BUILD A HEALTHIER COMMUNITY
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCEPART VIMUHLENBERG COMMUNITY HOSPITAL REACHES OUT TO EDUCATE PATIENTS ABOUT THE PATIENT FINANCIAL ASSISTANCE PROGRAM THE PATIENT FINANCIAL ASSISTANCE PROGRAM INFORMATION IS INCLUDED IN THE PATIENT INFORMATION HANDBOOK THAT IS GIVEN TO EVERY PATIENT AT THE TIME OF REGISTRATION THE ADMISSION CONSENT FORM ALSO INCLUDES AN ACKNOWLEDGEMENT BY THE PATIENT THAT THEY WERE GIVEN THE HANDBOOK IN ADDITION SELFPAY PATIENTS ARE INFORMED OF FEDERAL STATE AND LOCAL GOVERNMENTAL ASSISTANCE PROGRAMS WITHIN 24 HOURS OF ADMISSION SELFPAY PATIENTS ARE VISITED BY A FINANCIAL COUNSELOR AND INFORMED OF THE AVAILABLE PROGRAMS
COMMUNITY INFORMATIONPART VITHE PRIMARY SERVICE AREA FOR MUHLENBERG COMMUNITY HOSPITAL IS MUHLENBERG COUNTY KENTUCKY POPULATION OF 31181 IN 2012 LOCATED 115 MILES NORTH OF NASHVILLE TN 125 MILES WOUTHWEST OF LOUISVILLE KY AND 70 MILES SOUTH OF EVANSVILLE IN THE HOSPITALS SECONDARY SERVICE AREA INCLUDES PARTS OF HOPKINS TODD OHIO MCLEAN BUTLER LOGAN AND CHRISTIAN COUNTIES WHICH ARE THE SURROUNDING COUNTIES THE ESTIMATED PERCENTAGE OF PEOPLE LIVING BELOW THE POVERTY LEVEL AS DETERMINED BY THE US CENSUS BUREAU 20082012 IS 193 FOR MUHLENBERG COUNTY AND AN AVERAGE OF 201 OF THE SECONDARY SERVICE AREA THE AREA IS MOSTLY RURAL WITH A HIGHER PERCENTAGE OF PERSONS OVER THE AGE OF 65 AND A SIGNIFICANTLY LOWER MEDIAN HOUSEHOLD INCOME THAN FOR ALL OF KENTUCKY THE AVERAGE UNEMPLOYMENT RATE IN MUHLENBERG COUNTY FOR THE THE CALENDAR YEAR 2012 WAS 78 COMPARED TO THE STATE AVERAGE OF 95
HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSEPART VIMUHLENBERG COMMUNITY HOSPITAL AND ITS EMPLOYEES HAVE A RICH HISTORY OF PLANNING ANDOR SPONSORING EVENTS DESIGNED TO EDUCATE THE COMMUNITY ON HEALTHY LIVINGAND WELLNESS FACTORS EVENTS DURING THE FISCAL YEAR ENDING 9302013 INCLUDED HEALTH FAIRS AND SCREENINGS FOR THE COMMUNITY AND PRIVATE ORGANIZATIONS MUHLENBERG COMMUNITY HOSPITAL ADHERES TO THE FOLLOWING IRS EXEMPTION REQUIREMENTS A ACCEPT AND TREAT MEDICARE AND MEDICAID PATIENTS B EMERGENCY DEPARTMENT OPEN TO ALL EMERGENT CASES REGARDLESS OF ABILITY TO PAY C OPEN MEDICAL STAFF THAT ALLOWS CREDENTIALED PHYSICIANS TO PRACTICE AT THE FACILITY D OPERATE UNDER COMMUNITY BOARDS CONTROL IT IS THE MISSION AND ONGOING GOAL OF THE LEADERSHIP AND EMPLOYEES OF MUHLENBERG COMMUNITY HOSPITAL TO DO THE BEST JOB POSSIBLE TREATING THE SICK AND INJURED ADDRESSING COMMUNITY WELLNESS NEEDS AND PROMOTING HEALTHY LIVING AT EVERY OPPORTUNITY THROUGH OUR MANY COMMUNITY BENEFIT ACTIVITIES OUR CHARITY CARE PROGRAM AND OUR ACCEPTANCE OF PATIENTS COVERED BY FEDERAL AND STATE PROGRAMS MUHLENBERG COMMUNITY HOSPITAL MAKES A POSITIVE DIFFERENCE IN THE QUALITY OF LIFE IN THE COMMUNITY WE SERVE
MUHLENBERG COMMUNITY HOSPITAL INC LINE NUMBER 1 PART V LINE 1JPART V LINE 1JTHE CHNA ALSO OUTLINES HOSPITAL UTILIZATION DATA INCLUDING TABLES OUTLINING DISCHARGES TOTAL CHARGES AND AVERAGE CHARGES BY THE FOLLOWING CATEGORIES HOSPITAL INPATIENT AND OUTPATIENT DISCHARGES HOSPITAL INPATIENT AND OUTPATIENT PAYER MIX AND HOSPITAL INPATIENT DIAGNOSIS RELATED GROUP
MUHLENBERG COMMUNITY HOSPITAL INC LINE NUMBER 1 PART V LINE 3PART V LINE 3IN CONDUCTING THE CHNAINPUT WAS GATHERED FROM FOCUS GROUPS THREE FOCUS GROUPS WERE CONDUCTED THROUGHOUT THE COMMUNITY AND IN CONJUNCTION WITH OTHER MEETINGS THE SENIOR POPULATION AND THE UNDERSERVED WERE TARGETED AND PARTICIPATED IN A FOCUS GROUP WHILE TWO OTHER FOCUS GROUPS TOOK PLACE WITH THE STEERING COMMITTEE AND THE ECONOMIC DEVELOPMENT COMMUNITY THE STEERING COMMITTEE INCLUDED VARIOUS MEMEBERS OF THE COMMUNITY EACH MEMBER WAS FROM AREAS IN OR AROUND THE IMMEDIATE SERVICE AREA INCLUDED WERE A CEO OF A NEARBY HEALTH CENTER A MINISTER A SENIOR CITIZEN CENTER REPRESENTATIVE A HEALTH DEPARTMENT REPRESENTATIVE A COOPERATIVE EXTENSION SERVICE REPRESENTATIVE A SHERIFF A DENTIST A JUDGE EXECUTIVE A REPRESENTATIVE FROM THE CONVENTION CENTER A REPRESENTATIVE FROM THE FAMILY RESOURCE CENTER AN EXECUTIVE DIRECTOR OF A MENTAL HEALTH FACILITY A CHAMBER OF COMMERCE REPRESENTATIVE A FAMILY PRACTICE REPRESENTATIVE A FOUNDATION REPRESENTATIVE AND VARIOUS OTHER COMMUNITY MEMEBERS
MUHLENBERG COMMUNITY HOSPITAL INC LINE NUMBER 1 PART V LINE 6IPART V LINE 6IMUHLENBERG COMMUNITY HOSPITAL WILL KICK OFF THE IMPLEMENTATION STRATEGY BY INITIATING COLLABORATIVE EFF ORTS WITH COMMUNITY LEADERS TO ADDRESS EACH HEALTH PRIORITY IDENTIFIED THROUGH THE ASSESSMENT PROCESS PERIODIC EVALUATION OF GOALSOBJECTIVES FOR EACH IDENTIFIED PRIORITY WILL BE CONDUCTED TO ASSURE THAT WE ARE ON TRACK TO COMPLETE OUR PLAN AS DESCRIBED AT THE END OF FISCAL YEAR 2016 MUHLENBERG COMMUNITY HOSPITAL WILL REVIEW THE IMPLEMENTATION STRATEGY AND REPORT ON THE SUCCESS EXPERIENCED THROUGH THE COLLABORATIVE EFFORTS OF IMPROVING THE HEALTH OF THE COMMUNITY
MUHLENBERG COMMUNITY HOSPITAL INC LINE NUMBER 1 PART V LINE 7PART V LINE 7HOSPITAL BOARD TERM LIMITS DIVERSITY TERM LIMITS HAVE BEEN DISCUSSED AND ADDITIONAL BOARD MEMBERS ARE CURRENTLY BEING ADDED THE BOARD WILL CONTINUE TO WORK WITH THE ADMINISTRATION TO PROVIDE TRANSPARENCY IN MATTERS THAT BENEFI T THE COMMUNITY ASSISTED LIVING FACILITY THIS IS OUT OF THE SCOPE OF THE HOSPITALS SERVICES HOWEVER THE HOSPITAL OFFERS HOME HEALTH SERVICES AND THERE ARE LOCAL NURSING HOMES AND AN ASSISTED LIVING FACILITY IN THE COMMUNITY ADULT DAY CARE PROGRAM THIS IS OUT OF THE SCOPE OF THE HOSPITALS SERVICES CANCER TREATMENT THE HOSPITAL CURRENTLY HAS TWO PHYSICIANS WHO HAVE AN ESTABLISHED RELATIONSHIP WITH THE HOSPITAL AND SEE PATIENTS ON A WEEKLY BASIS PATIENTS ARE ABLE TO ACCESS FOLLOW UP APPOINTMENTS AND CHEMOTHERAPY AS ORDERED BY THE PHYSICIANS IN THE HOSPITAL IN ADDITION CANCER TREATMENT IS AVAILABLE WITHIN A 45 MINUTE DRIVE FROM THE HOSPITAL LOCAL PHYSICIANS WHY DONT THEY REFER TO HOSPITAL THE MAJORITY OF THE LOCAL PRIMARY CARE PHYSICIANS ARE EMPLOYED BY BAPTIST HEALTH SYSTEM AND REFER TO THEIR FACILITIES MUHLENBERG COMMUNITY HOSPITAL CONTINUES TO MARKET THE HOSPITALS SERVICES TO ALL PHYSICIANS AND HEALTH CARE PROVIDERS IN THE COMMUNITY DENTIST ON STAFF ACCESS FOR AFTER HOURS AND EMERGENCY CARE THE HOSPITAL HAS A DENTIST ON STAFF BUT THEY DO NOT PRACTICE IN THE HOSPITAL AND PRIMARILY MAKE VISITS FOR THE LONG TERM CARE UNIT A LIST OF PROVIDERS IS AVAILABLE TO PATIENTS UPON REQUEST OUTPATIENT LABS AND DIAGNOSTICS PRICES ARE TOO HIGH MUHLENBERG COMMUNITY HOSPITAL WILL CONTINUE TO OFFER COMPETITIVE PRICES TO THE COMMUNITY WOMENS SHELTER AND HOMELESS SHELTER THIS IS OUT OF THE SCOPE OF THE HOSPITALS SERVICES AND THERE ARE FACILITIES WITHIN 45 MINUTES OF THE HOSPITAL SANCTUARY HOUSE PITINO CENTER BOULWARE CENTER AND OASIS ACCESS TO FRONT DOORS IN ORDER TO MAINTAIN PATIENT AND STAFF SAFETY ALL DOORS EXCEPT ER ARE LOCKED AT 8 PM VISITING HOURS TO PATIENT ROOMS END AT 8PM AND THE DOORS ARE LOCKED IN ACCORDANCE TO VISITING HOURS OBSTETRIC CARE THE OB UNIT OF THE HOSPITAL WAS CLOSED IN AUGUST OF 2012 DUE TO LACK OF OBGYN SERVICES ARE AVAILABLE WITHIN 45 MINUTES OF THE HOSPITAL MEDICAID PATIENTS ACCESS TO SERVICES THE HOSPITAL DOES NOT LIMIT ANY SERVICES TO MEDICAID PATIENTS DRUG TREATMENT FACILITY THIS IS CURRENTLY OUT OF THE SCOPE OF THE HOSPITALS SERVICES MENTAL HEALTH TREATMENT THE COUNTY HAS LOCAL ACCESS TO MENTAL HEALTH TREATMENT THROUGH PENNYROYAL AREA COMMUNITY SERVICES
MUHLENBERG COMMUNITY HOSPITAL INC LINE NUMBER 1 PART V LINE 14GPART V LINE 14GTHE HOSPITAL SCREENS ALL PATIENTS FOR MEDICAID DSH AND CHARITY
MUHLENBERG COMMUNITY HOSPITAL INC LINE NUMBER 1 PART V LINE 20DPART V LINE 20DTHIS HOSPITAL FOLLOWS THE ESTABLISHED POLICY FOR FINANCIAL ASSISTANCE

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrg
JOHN COUNTZLER
CEO
JOSEPH SWAB
CFO
DR VINCENT GENOVESE
PHYSICIAN400005400005
DR TERRY HOLT
PHYSICIAN224994224994
DR SHANE NAPIER
PHYSICIAN200462200462

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierOTHER ADDITIONAL INFORMATIONIdentifier
Return ReferenceSCHEDULE J, PART IIIReturnReference
ExplanationMUHLENBERG COMMUNITY HOSPITAL HIRED ALLIANT MANAGEMENT SERVICES (ALLIANT) TO PROVIDE MANAGEMENT SERVICES FOR THE HOSPITAL. ALLIANT IS RESPONSIBLE FOR PROVIDING THE HOSPITAL WITH A CEO AND CFO AS WELL AS PAYING THEIR ANNUAL SALARIES.Explanation

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1KENTUCKY EMERGENCY ROOM PHYSICIANSBusinessNameLine1
FieldValueIRS element (for citing)
RelationshipDR. KEITH-OWNERRelationship
Amount Of Transaction491049AmountOfTransaction
Description Of TransactionER PHYSICIAN SERVICEDescriptionOfTransaction
Sharing Of RevenuesfalseSharingOfRevenues

Form990 Schedule L Part V Form990ScheduleLPartV

FieldValueIRS element (for citing)
IdentifierADDITIONAL INFORMATIONIdentifier
Return ReferenceSCHEDULE L PART VReturnReference
ExplanationREGARDING TRANSACTIONS DISCLOSED IN PART IV ABOVE THE TRANSACTIONS WITH KENTUCKY EMERGENCY ROOM PHYSICIANS KERP ARE FOR EMERGENCY DEPARTMENT AND HOSPITALIST COVERAGE THESE PAYMENTS REPRESENT TRANSACTIONS BASED ON FAIR MARKET VALUE OF SERVICES PROVIDED THE KERP TRANSACTIONS ARE REVIEWED AND APPROVED BY THE BOARD OF TRUSTEESExplanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
EXPLANATION ON VOLUNTEERS AND TYPES OF SERVICES OR BENEFITSFORM 990, PAGE 1, PART I, LINE 6VOLUNTEERS PROVIDE NON-CLINICAL SERVICES, INCLUDING OFFICE ASSISTANCE, STAFFING THE INFORMATION DESK, AND OPERATING THE GIFT SHOP.
RELATED PARTY INFORMATION AMONG OFFICERSFORM 990, PAGE 6, PART VI, LINE 2DR MARY K BROWN LANIE WEBB GARDNER BOARD MEMBER BOARD MEMBER FAMILY RELATIONSHIP CHARLES R LEWIS DR WILLARD KEITH BOARD MEMBER BOARD MEMBER BUSINESS RELATIONSHIP
MANAGEMENT DELEGATEDFORM 990, PAGE 6, PART VI, LINE 3THE CHIEF EXECUTIVE OFFICER OF THE HOSPITAL IS EMPLOYED BY ALLIANT MANAGEMENT SERVICES AND IS RESPONSIBLE FOR CONTROLLING MANAGEMENT DUTIES.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990FORM 990, PAGE 6, PART VI, LINE 11BTHE CEO REVIEWS THE 990 WITH THE BOARD OF DIRECTORS BEFORE IT IS SUBMITTED TO THE INTERNAL REVENUE SERVICE.
ENFORCEMENT OF CONFLICTS POLICYFORM 990, PAGE 6, PART VI, LINE 12CALL MANAGEMENT EMPLOYEES AND BOARD MEMBERS ARE REQUIRED TO UPDATE AND SIGN OFF ON A CONFLICT OF INTEREST POLICY ON AN ANNUAL BASIS.
COMPENSATION PROCESS FOR TOP OFFICIALFORM 990, PAGE 6, PART VI, LINE 15AALLIANT MANAGEMENT SERVICES EMPLOYS THE HOSPITAL'S CEO AND CFO. THEY PERFORM COMPARABILITY STUDIES AND RECOMMEND SALARY PACKAGES TO THE HOSPITAL'S PERSONNEL COMMITTEE. THE SALARY PACKAGES ARE REVIEWED AND APPROVED BY THE HOSPITAL'S PERSONNEL COMMITTEE.
COMPENSATION PROCESS FOR OFFICERSFORM 990, PAGE 6, PART VI, LINE 15BCOMPARABILITY DATA IS REVIEWED REGARDING THE CEO AND CFO'S SALARY PACKAGES. THE SALARY PACKAGES ARE REVIEWED AND APPROVED BY THE HOSPITAL'S FINANCE COMMITTEE ON AN ANNUAL BASIS.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATIONFORM 990, PAGE 6, PART VI, LINE 19GOVERNING DOCUMENTS ARE MADE AVAILABLE UPON REQUEST.
OTHER FEES FOR SERVICESFORM 990, PART IX, LINE 11GOTHER FEES FOR SERVICES 3,478,787 0 0

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1MUHLENBERG SURGERY CENTER LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11008 MEDICAL CENTER DRIVEAddressLine1
CityPOWDERLYCity
StateKYState
ZIP Code42367ZIPCode
FieldValueIRS element (for citing)
EIN611398071EIN
Primary ActivitiesSURGERYPrimaryActivities
Legal Domicile StateKYLegalDomicileState
Total Income-62492TotalIncome
EOY Assets1049996EOYAssets

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1MCHBusinessNameLine1
Business Name Line2COMMUNITY HOSPITALBusinessNameLine2

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1THE MUHLENBERG COMMUNITY HOSPITAL FBusinessNameLine1
Business Name Line2OUNDATIONBusinessNameLine2

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1440 HOPKINSVILLE STAddressLine1
CityGREENVILLECity
StateKYState
ZIP Code423450387ZIPCode
FieldValueIRS element (for citing)
EIN261600611EIN
Primary ActivitiesFUNDRAISINPrimaryActivities
Legal Domicile StateKYLegalDomicileState
Exempt Code Section501C3ExemptCodeSection
Public Charity Status9PublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1MCHBusinessNameLine1
FieldValueIRS element (for citing)
Controlled OrgfalseControlledOrg

Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAPredominant Income TypePredominantIncomeTypeShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsDisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartnerPercentage OwnershipPercentageOwnership
MUHLENBERG MEDICAL PROPERTIES IV LL
1010 MEDICAL CENTER DRIVEPOWDERLYKY42367010571762LESSORKYN/ARELATED51757356485falsetrue0.49000
GENESIS HEALTH ALLIANCE LLC
3700 WASHINGTON AVENUEEVANSVILLEIN47714208223181PURCHASINGINN/ARELATED98011437falsetrue0.04350
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Dividends Related OrganizationfalseDividendsRelatedOrganization
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

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