2013-01-15T11:46:30-07:00 2012-02-29 990 2011-03-01 310949874 MONROE MEDICAL FOUNDATION INC MONR 2704879231 529 CAPP HARLAN ROAD TOMPKINSVILLE KY 42167 Rickie Brown 2704879231 2013-01-14 2011 2016-02-25 16:41:14Z Monroe County Medical Center Rickie F Brown 529 Capp Harlan Road Tompkinsville KY 42167 20881393 0 X www.mcmccares.com X 1979 KY ACUTE CARE HOSPITAL - Our mission is to be a rural healthcare organization who values compassion, respect and confidentiality, and provide quality, safe, primary and specialty services for the citizens of Monroe County and surrounding area through detection prevention and treatment of illness. We achieve this by operating a 49 bed acute care hospital, ambulance service, home health agency, HCB Waiver program, physician office and county 911 service. 9 7 283 0 0 0 461942 465766 20147129 20317542 89178 95372 777 2713 20699026 20881393 24741 48845 0 0 10627206 10751991 0 0 0 9125584 9202068 19777531 20002904 921495 878489 23541254 24555387 1031334 1166978 22509920 23388409 ACUTE CARE HOSPITAL - The mission of the Monroe Medical Foundation, Inc. is to be a rural healthcare organization who values compassion, respect and confidentiality, and provides quality, safe, primary and specialty services for the citizens of Monroe County and surrounding area through detection, prevention and treatment of illness. We achieve this by operating a 49 bed acute care hospital, ambulance service, home health agency, HCB Waiver program, physician office and county 911 service. 0 0 18108626 48845 20330055 Inpatient Care - Monroe Medical Foundation, Inc. operates a 49 bed acute care hospital. The hospital admitted 2,183 patients, treated 8,130 patients in the emergency room, treated 22,395 patients as outpatient referrals and made 2,257 ambulance runs in FYE 02-29-12. The hospital also operates a home health agency which made 1,534 skilled visits, 3,550 home health aide visits, 986 physical therapy visits, 79 speech therapy visits, 55 social worker visits and 177 occupational therapy visits. The home health agency also operates a HCB Waiver Program which did 2,431 homaker units, 326 case management units, 106 respite units, 6 assessments and 24 reassessments during the fiscal year. The patients admitted to the hospital consisted of approximately 58% Medicare patients and 22% Medicaid patients. Approximately 7% of patients admitted did not have Medicare or Medicaid, and did not have any type of insurance. (7 high school graduates scholarships and 6 others majoring in healthcare profession). 0 0 0 18108626 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 24 0 1 283 1 0 0 0 0 0 0 0 0 0 1 1 0 X 9 7 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X Monroe County Medical Center 2704879231 529 CAPP HARLAN ROAD TOMPKINSVILLE KY 42167 Judy Rowland 1 X X 0 0 0 Fowler Ross JR OD 1 X 0 0 0 Jimmy Goodman 1 X X 0 0 0 Mike Starnes 1 X 0 0 0 Timothy Hume MD 1 X 0 0 0 Polly Baker 1 X 0 0 0 Gene Hagan 1 X 0 0 0 Greg Crabtree DMD 1 X 0 0 0 Jerry Bean MD 1 X 0 0 0 Anthony Carter MD 2 X 2850 0 0 Vicky McFall 40 X 0 0 0 Rickie Brown 40 X 0 0 0 Deborah Bentley 40 X 130669 0 0 Andrea McAlpin 40 X 128390 0 0 Clella Hays MD 40 X 165000 0 0 426909 0 0 3 0 1 0 Quorum Health Resources LLC 105 Continental Place Brentwood TN 37027 Management Contract & Provides CEO and CFO 629389 Inspire Medical Inc 2323 Lime Kiln Lane Louisville KY 40222 Emergency Room Physicians 1088185 CPSI 6600 Wall St Mobile AL 36695 Computer Software and Maintenance 155773 Philips Medical Systems P O Box 100355 Atlanta GA 30384 Maintenance services on radiology equipment 271183 Healthcare Management Systems Inc 6550 Carothers Parkway Suite 100 Franklin TN 37067 Computer Software Hardware and Maintenance 799696 5 0 0 0 0 465766 0 0 465766 Hospital Services Net of Contractual Adjustments 622000 20317542 20317542 0 0 0 0 0 0 20317542 85572 0 0 85572 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9800 0 0 0 9800 9800 9800 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2713 2713 0 0 2713 20881393 20330055 0 85572 0 0 48845 48845 0 0 0 0 0 0 0 0 0 0 0 0 9043981 8417622 626359 0 137265 127657 9608 0 911504 847699 63805 0 659241 613094 46147 0 626984 0 626984 0 888 0 888 0 29650 0 29650 0 0 0 0 0 0 0 0 0 0 0 237528 181690 55838 0 14938 14938 0 0 2708311 2632656 75655 0 129926 106042 23884 0 0 0 0 0 421247 321833 99414 0 78346 66114 12232 0 0 0 0 0 7042 6427 615 0 0 0 0 0 0 0 0 0 1127834 1095609 32225 0 150420 143104 7316 0 Provision for Bad Debts 1244526 1244526 0 0 Physician Fees 1214506 1214506 0 0 Equipment Repairs and Maintenance 567767 550839 16928 0 Kentucky Provider Tax 315533 315533 0 0 326622 159892 166730 0 20002904 18108626 1894278 0 1149 4050 1293899 779759 0 0 2808830 2531592 0 0 0 0 0 0 307078 304190 230658 187570 30571877 17088357 13202458 13483520 0 0 0 0 0 0 0 0 5697182 7264706 23541254 24555387 1031334 1166978 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1031334 1166978 X 22370071 23280896 139849 107513 0 0 22509920 23388409 23541254 24555387 878489 0 X 0 1 1 X 0 X 0 378922 378922 0 12231409 4034579 8196830 0 0 0 0 0 17961546 13053778 4907768 0 0 0 0 13483520 Funded Depreciation 6606371 Cash Restricted for Adult Daycare 16839 Other Receivables 634121 Other Assets 7375 7264706 20881393 20002904 878489 0 0 0 0 0 0 878489 20881394 0 0 0 1 1 20881393 0 0 0 20881393 20002905 0 0 0 1 1 20002904 0 0 0 20002904 SchD_P12_S00_L02d Schedule D, Part XII, Line 2d Rounding SchD_P13_S00_L02d Schedule D, Part XIII, Line 2d Rounding 1 1 X 1 X 1 X 1 1 0 1 1 1080402 222842 857560 0.0457 2723708 2224092 499616 0.0266 0 0 0 0 0 0 3804110 2446934 1357176 0.0723 13895 0 13895 0.0008 48845 0 48845 0.0026 1284023 1155458 128565 0.0027 0 0 0 0.00 0 0 0 0.00 0 0 1346763 1155458 191305 0.0061 0 0 5150873 3602392 1548481 0.0784 1 547591 109518 9385183 8404840 980343 X 1 1 Quorum Health Resources LLC Management Company 0 0 0 1 1 Monroe County Medical Center

529 Capp Harlan Road Tompkinsville KY 42167

X X X Monroe County Medical Center 1 0 1 1 100 1 200 1 X X 1 1 X X X X 1 0 X X X X 1 X 0 1 2 Monroe County Medical Center Home Health Agency

417 Capp Harlan Road Tompkinsville KY 42167

Home Health Services and HCB Waiver Program Monroe County Medical Center Adult Daycare

417 Capp Harlan Road Tompkinsville KY 42167

Provides Adult Daycare Services Monroe County Ambulance Service

415 Capp Harlan Road Tompkinsville KY 42167

Ambulance Service operated for the county. Monroe County 911 Service

415 Capp Harlan Road Tompkinsville KY 42167

911 Service operated for the county. SchH_P01_S00_L07 Schedule H, Part I, Line 7 Ratio of Patient Care Cost to Charges was used as the costing methology. SchH_P01_S00_L07g Schedule H, Part I, Line 7g There were no costs attributable to a physician clinic included as subsidized health services in line 7(g). SchH_P03_S0A_L04 Schedule H, Part III, Section A, Line 4 The costing methodology used to determine the amounts reported is based on the Ratio of Patient Care Cost to Charges applied to the gross amounts written off as bad debts. SchH_P03_S0B_L08 Schedule H, Part III, Section B, Line 8 There is no shortfall on Medicare. The costing methodology used is the Ratio of Patient Care Cost to Charges applied to the gross charges. SchH_P03_S0C_L09b Schedule H, Part III, Section C, Line 9b Upon registration, financial information is gathered, when possible, to determine if they qualify for charity or financial assistance. If they are not able to provide the information at that time they are given a financial information form to complete later. If they are admitted to the hospital, the patient financial counseler goes to the patient room and discusses the charity and financial assistance information with the patient. If we are unable to obtain the necessary information from the patient at that time, we send the information to a contracted company to obtain the necessary information, and assist them in obtaining the information and financial assistance they qualify for. SchH_P05_S0B_L21 Schedule H, Part V, Section B, Line 21 The hospital has the same charges for all patients. If the patients meet the indigent policy criteria, a portion of their bill is adjusted according to the indigent care policy. Patients who meet the KHCP program criteria are totally written off, and the patients are not responsible for the bill. Other patients have the opportunity to receive a discount on their bill equivalent to the negotiated commercial insurance rate. SchH_P06_S00_L02 Schedule H, Part VI, Line 2 In the past the Community Needs Assessment has been developed in connection with the Monroe County Health Department. It has been a while since one was completed. We are currently in the process of doing a joint communtiy needs assessment with the Monroe County Health Department and the Barren River Area Development District (BRADD). This assessment is basically complete, but it is in our FYE 02-28-13 fiscal year. The hospital also has suggestion boxes for patients, visitors and employees to obtain suggestions for new or better health services. In addition, the hospital obtains input from the physicians, Board members and employees at the annual hospital, Board/Medical Staff planning retreat. SchH_P06_S00_L03 Schedule H, Part VI, Line 3 The Indigent Care Policy is posted on the wall in the registration offices. There are also copies in the registration areas with a sign instructing the patients to take one if they feel they may qualify for the financial assistance. If the patients do not have Medicare, Medicaid or any other type of insurance, the patient informatin is provided to a contracted company to follow up with the patients to help them obtain medical cards and assist them in getting the necessary information to qualify for financial assistance. If the patient is admitted, the Patient Financial Counselor vistis the patient in their patient room and discusses their financial options. The hospital's Indigent Care Policy is posted on the hospital's web site. SchH_P06_S00_L04 Schedule H, Part VI, Line 4 The Monroe County Medical Center is located in Monroe County, Kentucky which is a rural area of Kentucky. The hospital primarily serves the citizens of Monroe County and parts of the joining counties. The population of Monroe County is approximately 10,900. Approximately 11.6% of persons age 25 and above have a bachelor's degree or higher compared to 30.44% for the national average. The median household income is approximately $28,439 compared to the national medican household income of $46,326. Approximately 27.1% of the persons in Monroe County live below the poverty level compared to 15.1% for the national average. The unemployment rate for Monroe County is 12.0% compared to the national average of 8.9%. The primary industries in Monroe County are a concrete plant manufacturer, lumber and agriculture. SchH_P06_S00_L05 Schedule H, Part VI, Line 5 The Monroe County Medical Center has an open medical staff to promote patient care for the citizens of our community. The Board of Directors of the Monroe Medical Foundation, Inc. is made up of nine individuals. They all reside in Monroe County, and serve on the Board with no pay for providing those services. They serve because they are interested in the Community and want to give something back to the Community by helping assure that good medical services are provided to the citizens of Monroe and surrounding counties. The current Board is made up of two local business men, a banker, a retired banker and farmer, a retired school teacher, a dentist, an optomitrist, the chief of the medical staff and the vice chief of the medical staff. Any surplus funds of the Monroe Medical Foundation, Inc. are used to upgrade the building, purchase updated equipment and provide other wellness services and quality healthcare for our community. SchH_P06_S00_L06 Schedule H, Part VI, Line 6 The hospital is managed by Quorum Health Resources, LLC to provide the day-to-day management of the hospital; however, the Board of Directors has the ultimate decision making authority for the hospital. 1 Grant and Tuition Reimbursement for nursing school. 3 11017 0 Assistance for Paramedic training. 1 10470 0 Occupational Therapist tuition assistance. 1 9108 0 Physical Therapy tuition assistance. 1 10000 0 High School senior scholarships. 8 8250 0 SchI_P01_S00_L02 Schedule I, Part I, Line 2 The grant funds and assistance are monitored by CEO, CFO and the Board of Directors. The Board of Directors approves the grants or other assistance for education etc.. The individuals are required to provide proof of enrollment, etc., and appropriate grades to receive the grants or assistance. X 0 0 0 0 0 0 0 0 0 Clella Hays MD 165000 0 0 0 0 0 3712 0 4147 0 172859 0 0 SchJ_P01_S00_L03 Schedule J, Part I, Line 3 Compensation paid to Vicky McFall, CEO and Rickie Brown, CFO was paid by Quorum Health Resources, LLC which is the management company. The compensation is approve by the Board of Directors of the Monroe County Medical Center. Gene Hagan Board Member 1190 Purchase of supplies 0 Terry L Carter Duughter of Board Member 64950 Employee wages for RN 0 Jo Ann Brown Spouse of CFO 66609 Employee wages for RN 0 Emily J Shaw Daughter of CFO 33785 Employee wages for RN 0 Anthony C Carter MD Board Member 2850 Stress Tests 0 F990_P06_S0A_L03 Form 990, Part VI, Section A, Line 3 The Monroe Medical Foundation, Inc. has contracted with a management company, Quorum Health Resources, LLC to provide management services to the hosp[ital. The CEO and CFO are employees of the management company, but they are still under the control of the Board of Directors. The CEO and CFO report to the Board of Directors each month at the Board meetings and other times as necessary. F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b The Form 990 is prepared by the CFO and is reviewed with the CEO before it is filed. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c Each member of the Board of Directors and the CEO and CFO completes a conflict of interest questionaire annually. Any time there is a conflict of interest with any Board Member on any issue being discussed by the Board of Directors, the Board member who has the conflict abstains from any vote on the issue. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 The process for determining compensation of the CEO and CFO includes a review and approval by Quorum Health Resources, LLC, the management company, and the Board of Directors. Each member of the Board of Directors completes an evaluation of the CEO, and submits it to the Quorum Regional Vice President. The Regional Vice President presents the evaluations and his recommendations to the Board of Directors based on the evaluations and the salary scale of the management company. The Board of Directors approves or disapproves the recommendation of the Quorum Regional Vice President. The CEO completes the evaluation of the CFO and submits it to the Quorum Regional Vice President. The Regional Vice President presents his recommendations to the Board of Directors based on the evaluation and the salary scale of the management company. The Board of Directors approves or disapproves the recommendation of the Quorum Regional Vice President. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 The governing documents, conflict of interest policy, and financial statements are available to the public upon request in the Administrative office of the Monroe County Medical Center, 529 Capp Harlan Road, Tompkinsville, Kentucky 42167. I filed an automatic extension on July 15, 2012. I filed an additional 3 month extension on October 12, 2012 because we needed additional time to file the return until the independent audit was completed so the return could accurately include any adjustments with the audit. We were waiting to finalize the audit to get the SSI percentage published amounts verified because they appeared to be incorrect. We needed the additional time to file an accurate Form 990 return.