FURP.ORG / PUBLIC DATA EXPLORER

MONROE MEDICAL FOUNDATION INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
MONROE MEDICAL FOUNDATION INC (EIN 31-0949874)
Tax period
2010-03-01 to 2011-02-28
Filed
2012-03-29
IRS object ID
201230909349300413
Schema version
2010v3.4
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)
Timestamp2012-03-29T16:48:32-07:00Timestamp
Tax Period End Date2011-02-28TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2010-03-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN310949874EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1MONROE MEDICAL FOUNDATION INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMONRNameControl
Phone2704879231Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1529 CAPP HARLAN ROADAddressLine1
CityTOMPKINSVILLECity
StateKYState
ZIP Code42167ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameRickie BrownName
TitleChief Financial OfficerTitle
Phone2704879231Phone
Date Signed2012-03-23DateSigned
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1Monroe County Medical CenterBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonRickie F BrownNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1529 Capp Harlan RoadAddressLine1
CityTompkinsvilleCity
StateKYState
ZIP Code42167ZIPCode
FieldValueIRS element (for citing)
Gross Receipts20699026GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.mcmccares.comWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1979YearFormation
State Legal DomicileKYStateLegalDomicile
Activity Or Mission DescriptionACUTE 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.ActivityOrMissionDescription
Nbr Voting Members Governing Body9NbrVotingMembersGoverningBody
Nbr Independent Voting Members7NbrIndependentVotingMembers
Total Nbr Employees276TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year468631ContributionsGrantsPriorYear
Contributions Grants Current Year461942ContributionsGrantsCurrentYear
Program Service Revenue Prior Year20089033ProgramServiceRevenuePriorYear
Program Service Revenue CY20147129ProgramServiceRevenueCY
Investment Income Prior Year82407InvestmentIncomePriorYear
Investment Income Current Year89178InvestmentIncomeCurrentYear
Other Revenue Prior Year24056OtherRevenuePriorYear
Other Revenue Current Year777OtherRevenueCurrentYear
Total Revenue Prior Year20664127TotalRevenuePriorYear
Total Revenue Current Year20699026TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year31249GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY24741GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year10442469SalariesEtcPriorYear
Salaries Etc Current Year10627206SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year8725402OtherExpensePriorYear
Other Expenses Current Year9125584OtherExpensesCurrentYear
Total Expenses Prior Year19199120TotalExpensesPriorYear
Total Expenses Current Year19777531TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1465007RevenuesLessExpensesPriorYear
Revenues Less Expenses CY921495RevenuesLessExpensesCY
Total Assets BOY23012332TotalAssetsBOY
Total Assets EOY23541254TotalAssetsEOY
Total Liabilities BOY1423907TotalLiabilitiesBOY
Total Liabilities EOY1031334TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY21588425NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY22509920NetAssetsOrFundBalancesEOY
Mission DescriptionACUTE 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 treatmet 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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense16959166Expense
Grants24741Grants
Revenue20147129Revenue
DescriptionInpatient Care - Monroe Medical Foundation, Inc. operates a 49 bed acute care hospital. The hospital admitted 2,117 patients, treated 8,200 patients in the emergency room, treated 21,976 patients as outpatient referrals and made 2,066 ambulance runs in FYE 02-28-11. The hospital also operates a Home Health agency which made 1,623 skilled visits, 4,713 home health aide visits, 1,168 physical therapy visits, 95 speech therapy visits, 43 social worker visits and 95 occupational therapy visits. The home health agency also operates a HCB Waiver Program which did 2,865 homemaker units, 435 case management units, 133 respite units, 10 assessments and 29 reassessments during the fiscal year. The patients admitted to the hospital consisted of approximately 58% Medicare patients and 23% Medicaid patients. Approximately 8% of patients admitted did not have Medicare or Medicaid, and did not have any type of insurance. (6 high school graduates scholarships and 5 others majoring in healthcare profession)Description
Total Of Other Program Service Exp0TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt0TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev0TotalOfOtherProgramServiceRev
Total Program Service Expense16959166TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached0FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization1BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109622NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees276NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Form8899 Filed1Form8899Filed
Form1098 C Filed1Form1098CFiled
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members9NbrVotingGoverningBodyMembers
Number Independent Voting Members7NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body0Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Monroe County Medical CenterBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number2704879231TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1529 CAPP HARLAN ROADAddressLine1
CityTOMPKINSVILLECity
StateKYState
ZIP Code42167ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (16 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
Judy Rowland
Vice President1XX000
Fowler Ross JR OD
Board Member1X000
Jimmy Goodman
Board Member1X000
Johnny Travis
Board Member1X000
Timothy Hume MD
Board Member1X000
Polly Baker
Board Member1X000
Gene Hagan
Board Member1X000
Greg Crabtree DMD
President1XX000
Kimberly Eakle-Hume M D
Director7X2621000
Anthony Carter MD
Director2X245000
Vicky McFall
Exec Director/CEO40X000
Rickie Brown
Chief Financial Officer40X000
Deborah Bentley
Director of Pharmacy4012909300X
Andrea McAlpin
Pharmacist4012471000X
Clella Hays MD
Physician4016403900X
Lisa Davis
Director of Nursing4010113000X
FieldValueIRS element (for citing)
Total Reportable Comp From Org547632TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K4NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (4 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Quorum Health Resources LLC
105 Continental PlaceBrentwoodTN37027Management Contract & Provides CEO and CFO623574
Inspire Medical Inc
2323 Lime Kiln LaneLouisvilleKY40222Emergency Room Physicians1111905
CPSI
6600 Wall StMobileAL36695Computer Software and Maintenance210779
Philips Medical Systems
P O Box 100355AtlantaGA30384Maintenance services on radiology equipment274415
FieldValueIRS element (for citing)
Number Of Contractors GT100 K4NumberOfContractorsGT100K
Federated Campaigns0FederatedCampaigns
Membership Dues0MembershipDues
Fundraising Events0FundraisingEvents
Related Organizations0RelatedOrganizations
Government Grants461942GovernmentGrants
All Other Contributions0AllOtherContributions
Noncash Contributions0NoncashContributions
Total Contributions461942TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionHospital Services Net of Contractual Adjustments and CharityDescription
Business Code622000BusinessCode
Total Revenue Column20147129TotalRevenueColumn
Related Or Exempt Function Income20147129RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount
FieldValueIRS element (for citing)
Total Program Service Revenue20147129TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column89178TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$89,178ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real0Real
Personal0Personal

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real0Real
Personal0Personal

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real0Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities0Securities
Other0Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities0Securities
Other0Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities0Securities
Other0Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events0GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events0CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses0FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Gaming0GrossIncomeGaming
Gaming Direct Expenses0GamingDirectExpenses

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount
FieldValueIRS element (for citing)
Gross Sales Of Inventory0GrossSalesOfInventory
Cost Of Goods Sold0CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column777TotalRevenueColumn
Related Or Exempt Function Income777RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue777TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column20699026TotalRevenueColumn
Related Or Exempt Function Income20147906RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$89,178ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total24741Total
Program Services24741ProgramServices

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total8894559Total
Program Services8049783ProgramServices
Management And General844776ManagementAndGeneral
Fundraising0Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total133984Total
Program Services121259ProgramServices
Management And General12725ManagementAndGeneral
Fundraising0Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total940816Total
Program Services851460ProgramServices
Management And General89356ManagementAndGeneral
Fundraising0Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total657847Total
Program Services595367ProgramServices
Management And General62480ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total618743Total
Program Services0ProgramServices
Management And General618743ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total27899Total
Program Services0ProgramServices
Management And General27899ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total29552Total
Program Services0ProgramServices
Management And General29552ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total
Fundraising0Fundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total14589Total
Program Services14589ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total2586709Total
Program Services2372739ProgramServices
Management And General213970ManagementAndGeneral
Fundraising0Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total146447Total
Program Services0ProgramServices
Management And General146447ManagementAndGeneral
Fundraising0Fundraising

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total439814Total
Program Services0ProgramServices
Management And General439814ManagementAndGeneral
Fundraising0Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total80238Total
Program Services67112ProgramServices
Management And General13126ManagementAndGeneral
Fundraising0Fundraising

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total11719Total
Program Services10081ProgramServices
Management And General1638ManagementAndGeneral
Fundraising0Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1358780Total
Program Services1322195ProgramServices
Management And General36585ManagementAndGeneral
Fundraising0Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total153735Total
Program Services152054ProgramServices
Management And General1681ManagementAndGeneral
Fundraising0Fundraising

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
Provision for Bad Debts1097258109725800
Physician Fees1191412119141200
Other Expenses5188722536492652230
Equipment Repairs and Maintenance531372517022143500
Kentucky Provider Tax31844531844500

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total19777531Total
Program Services16959166ProgramServices
Management And General2818365ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY7397BOY
EOY1149EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY880848BOY
EOY1293899EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY4008073BOY
EOY2808830EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY334368BOY
EOY307078EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY222372BOY
EOY230658EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis29162981LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec15960523LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY14133917BOY
EOY13202458EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY3425357BOY
EOY5697182EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY23012332BOY
EOY23541254EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1029786BOY
EOY1031334EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY394121BOY
EOY0EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1423907BOY
EOY1031334EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY21407713BOY
EOY22370071EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY180712BOY
EOY139849EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY21588425BOY
EOY22509920EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY23012332BOY
EOY23541254EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses921495ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis378922OtherCostOrOtherBasis
Book Value378922BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis12210014OtherCostOrOtherBasis
Depreciation3691955Depreciation
Book Value8518059BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis0OtherCostOrOtherBasis
Depreciation0Depreciation
Book Value0BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis16574045OtherCostOrOtherBasis
Depreciation12268568Depreciation
Book Value4305477BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis0OtherCostOrOtherBasis
Depreciation0Depreciation
Book Value0BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings13202458TotalOfBookValueLandBuildings

Other Assets OtherAssets (4 entries)

DescriptionDescriptionBook ValueBookValue
Fubded Depreciation Restricted5059058
Cash Restricted for Adult Daycare16815
Other Receivables613934
Other Assets7375
FieldValueIRS element (for citing)
Total Book Value Other Assets5697182TotalBookValueOtherAssets
Total Revenue20699026TotalRevenue
Total Expenses19777531TotalExpenses
Excess Or Deficit For Year921495ExcessOrDeficitForYear
Net Unrealized GL On Investments0NetUnrealizedGLOnInvestments
Donated Services And Facilities0DonatedServicesAndFacilities
Investment Expenses0InvestmentExpenses
Prior Period Adjustments0PriorPeriodAdjustments
Other$0OtherAmount
Total Adjustments0TotalAdjustments
Excess Or Deficit Per FS921495ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt20699026TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments0NetUnrealizedGainsInvestments
Donated Srvc And Use Of Facilities0DonatedSrvcAndUseOfFacilities
Recoveries Of Prior Year Grants0RecoveriesOfPriorYearGrants
Other Revenues0OtherRevenues
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal20699026RevenueSubtotal
Investment Expenses Not Included0InvestmentExpensesNotIncluded
Other Revenues Not Included0OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99020699026TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt19777531TotExpensesEtcAuditedFinclStmt
Donated Services Use Of Facilities0DonatedServicesUseOfFacilities
Prior Year Adjustments0PriorYearAdjustments
Losses Reported0LossesReported
Other Expenses Included0OtherExpensesIncluded
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal19777531ExpensesSubtotal
Investment Expenses Not Included20InvestmentExpensesNotIncluded2
Other Expenses Not Included0OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99019777531TotalExpensesPerForm990

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent100XPcent100
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent200 DXPcent200D
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense1038224TotalCommunityBenefitExpense
Direct Offsetting Revenue300642DirectOffsettingRevenue
Net Community Benefit Expense737582NetCommunityBenefitExpense
Percent Of Total Expense0.0373PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense3050515TotalCommunityBenefitExpense
Direct Offsetting Revenue2544556DirectOffsettingRevenue
Net Community Benefit Expense505959NetCommunityBenefitExpense
Percent Of Total Expense0.0256PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense0TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense0NetCommunityBenefitExpense
Percent Of Total Expense0.00PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Number Of Activities Or Programs0NumberOfActivitiesOrPrograms
Persons Served0PersonsServed
Total Community Benefit Expense4088739TotalCommunityBenefitExpense
Direct Offsetting Revenue2845198DirectOffsettingRevenue
Net Community Benefit Expense1243541NetCommunityBenefitExpense
Percent Of Total Expense0.0629PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense7802TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense7802NetCommunityBenefitExpense
Percent Of Total Expense0.0004PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense24741TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense24741NetCommunityBenefitExpense
Percent Of Total Expense0.0013PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense1242393TotalCommunityBenefitExpense
Direct Offsetting Revenue1054973DirectOffsettingRevenue
Net Community Benefit Expense187420NetCommunityBenefitExpense
Percent Of Total Expense0.0095PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs0NumberOfActivitiesOrPrograms
Persons Served0PersonsServed
Total Community Benefit Expense1274936TotalCommunityBenefitExpense
Direct Offsetting Revenue1054973DirectOffsettingRevenue
Net Community Benefit Expense219963NetCommunityBenefitExpense
Percent Of Total Expense0.0112PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs0NumberOfActivitiesOrPrograms
Persons Served0PersonsServed
Total Community Benefit Expense5363675TotalCommunityBenefitExpense
Direct Offsetting Revenue3900171DirectOffsettingRevenue
Net Community Benefit Expense1463504NetCommunityBenefitExpense
Percent Of Total Expense0.0741PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$449,332BadDebtExpenseAmount
Amount Attributable To80880AmountAttributableTo
Amount Reimbursed By Medicare10717068AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare8996033CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall1721035MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV

Name Of Entity NameOfEntity

FieldValueIRS element (for citing)
Business Name Line1Quorum Health Resources LLCBusinessNameLine1
FieldValueIRS element (for citing)
Description Ent Primary ActivityManagement CompanyDescriptionEntPrimaryActivity
Organization Profit Or Ownership0OrganizationProfitOrOwnership
Officers Etc Profit Or Ownership0OfficersEtcProfitOrOwnership
Physicans Profit Or Ownership0PhysicansProfitOrOwnership
FieldValueIRS element (for citing)
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 Line1Monroe County Medical CenterBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1529 Capp Harlan RoadAddressLine1
CityTompkinsvilleCity
StateKYState
ZIP Code42167ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Monroe County Medical CenterBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
CHNA Conducted0CHNAConducted
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent100FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent200FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Posted In Admission OfficeXPostedInAdmissionOffice
Provided On AdmissionXProvidedOnAdmission
Available On RequestXAvailableOnRequest
Actions On Nonpayment1ActionsOnNonpayment
Permit Report To Credit AgencyXPermitReportToCreditAgency
Permit LawsuitXPermitLawsuit
Collection Activities1CollectionActivities
Report To Credit AgencyXReportToCreditAgency
LawsuitXLawsuit
Notify Upon AdmissionXNotifyUponAdmission
Notify Before DischargeXNotifyBeforeDischarge
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Lowest Negotiated RatesXLowestNegotiatedRates
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges1GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities2NumberOfOtherFacilities

Other Facilities OtherFacilities (4 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
Monroe County Medical Center Home Health Agency
417 Capp Harlan RoadTompkinsvilleKY42167Home Health Services and HCB Waiver Program.
Monroe County Medical Center Adult Daycare
417 Capp Harlan RoadTompkinsvilleKY42167Provides adult daycare services
Monroe County Ambulance Service
415 Capp Harlan RoadTompkinsvilleKY42167Ambulance Service operated for the county.
Monroe County 911 Service
415 Capp Harlan RoadTompkinsvilleKY42167911 service operated for the county.

Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
SchH_P01_S00_L07Schedule H, Part I, Line 7Ratio of Patient Care Cost to Charges was used as the costing methodology.
SchH_P01_S00_L072fSchedule H, Part I, Line 7, Column fBad debt expense at cost of $33,531 was removed and Charity Care expense at cost of $46,511 was removed from this figure for purposes of calculating the percentage in Schedule H, Part I, Line 7, Column (f).
SchH_P01_S00_L07gSchedule H, Part I, Line 7gThere were no costs attributable to a physician clinic included as subsidized health services in the line 7(g).
SchH_P03_S0A_L04Schedule H, Part III, Section A, Line 4The 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_L08Schedule H, Part III, Section B, Line 8There 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_L09bSchedule H, Part III, Section C, Line 9bUpon 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_L21Schedule H, Part V, Section B, Line 21The 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_L02Schedule H, Part VI, Line 2In 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 in the process of doing a joint community needs assessment with the Monroe County Health Department and the Barren River Area Development District (BRADD). 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_L03Schedule H, Part VI, Line 3The 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 information 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 visits 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_L04Schedule H, Part VI, Line 4The 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 median 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_L05Schedule H, Part VI, Line 5The 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_L06Schedule H, Part VI, Line 6The hospital is managed by Quorum Health Resources, LLC to provide the day-to-day management of the hospital. The Board of Directors has the ultimate decision making authority for the hospital.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantSee Schedule I, Part IV, Statement 1TypeOfGrant
Number Of Recipients11NumberOfRecipients
Amount Of Cash Grant24741AmountOfCashGrant
Amount Of Non Cash Assistance0AmountOfNonCashAssistance

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierSchI_P01_S00_L02Identifier
Return ReferenceSchedule I, Part I, Line 2ReturnReference
ExplanationThe grant funds or assistance is monitored by CEO, CFO and the Board of Directors. The Board of Directors approves teh 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.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII

FieldValueIRS element (for citing)
Name PersonClella Hays MDNamePerson
Base Compensation Filing Org165000BaseCompensationFilingOrg
Comp Based On Related Orgs0CompBasedOnRelatedOrgs
Bonus Filing Org0BonusFilingOrg
Bonus Related Orgs0BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs0OtherCompensationRelatedOrgs
Deferred Comp Filing Org2570DeferredCompFilingOrg
Deferred Comp Related Orgs0DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org4142NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs0NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org171712TotalCompensationFilingOrg
Total Compensation Related Orgs0TotalCompensationRelatedOrgs

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierSchJ_P01_S00_L03Identifier
Return ReferenceSchedule J, Part I, Line 3ReturnReference
ExplanationVicky McFall - Compensation paid to Vicky McFall, CEO and Rickie Brown, CFO was paid by Quorum Health Resources, LLC which is the management Company.Explanation

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (5 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
Gene Hagan
Board Member656Purchase of Supplies0
Johnny Travis
Board Member2762Purchase of Supplies0
Terry L Carter
Daughter of Board Member57485Employee Wages for RN0
Jo Ann Brown
Spouse of CFO60856Employee Wages for RN0
Emily J Shaw
Daughter of CFO43341Employee Wages for RN0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
F990_P06_S0A_L03Form 990, Part VI, Section A, Line 3The Monroe Medical foundation, Inc. has contracted with a management company, Quorum Health Resources, LLC, to provide management servcies to the hospital. 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 reports to the Board of Directors each month at the Board meetings and other times as necessary.
F990_P06_S0B_L11aForm 990, Part VI, Section B, Line 11aThe Form 990 is prepared by the CFO and is reviewed with the CEO before it is filed.
F990_P06_S0B_L12cForm 990, Part VI, Section B, Line 12cEach 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_L15Form 990, Part VI, Section B, Line 15The 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_L19Form 990, Part VI, Section C, Line 19The 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, Tomplinsville, Kentucky 42167.

Reasonable Cause Explanation ReasonableCauseExplanation

FieldValueIRS element (for citing)
ExplanationThe Monroe Medical Foundation, Inc. filed and received approval for an extension to file the Form 990 until January 15, 2012. I was trying to file the return the first of January and discovered that the IRS had suspended their electronic filing systems for the Form 990 through February 29, 2012. According to the IRS Notice 2012-4, an organization with a second extended due date that falls during the suspension period, the organization will have reasonable cause for late filing and will not be subject to the late filing penalties if it files by March 30, 2012. I respectfully request that you do not generate a penalty notice for late filing based on the Notice 2012-4. Thank you very much.Explanation