PINEVILLE COMMUNITY HOSPITAL ASSOC INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- PINEVILLE COMMUNITY HOSPITAL ASSOC INC (EIN 61-0541901)
- Tax period
- 2011-07-01 to 2012-06-30
- Filed
- 2012-11-09
- IRS object ID
- 201243149349300219
- Schema version
- 2011v1.2
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-09T08:16:25-06:00 | Timestamp |
| Tax Period End Date | 2012-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 610420207 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JONES NALE & MATTINGLY PLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 642 SOUTH FOURTH ST STE 300 | AddressLine1 |
| City | LOUISVILLE | City |
| State | KY | State |
| ZIP Code | 40202 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 610541901 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PINEVILLE COMMUNITY HOSPITAL ASSOC INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | PINE | NameControl |
| Phone | 6063373051 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 850 RIVERVIEW AVENUE | AddressLine1 |
| City | PINEVILLE | City |
| State | KY | State |
| ZIP Code | 40977 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | J MILTON BROOKS | Name |
| Title | CEO | Title |
| Phone | 6063373051 | Phone |
| Date Signed | 2012-11-02 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DAVID R PRICE | Name |
| PTIN | P01272254 | PTIN |
| Phone | 5025830248 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | J MILTON BROOKS | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 850 RIVERVIEW AVENUE | AddressLine1 |
| City | PINEVILLE | City |
| State | KY | State |
| ZIP Code | 40977 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 31404045 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.PINEVILLEHOSPITAL.COM | WebSite |
| Type Of Organization Association | X | TypeOfOrganizationAssociation |
| Year Formation | 1953 | YearFormation |
| State Legal Domicile | KY | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE, WITHIN OUR MEANS, QUALITY HEALTH CARE TO THE PEOPLE OF SOUTHEAST KENTUCKY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 11 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 11 | NbrIndependentVotingMembers |
| Total Nbr Employees | 334 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 257083 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -28119 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 28848840 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 29624002 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 340649 | InvestmentIncomePriorYear |
| Investment Income Current Year | 336877 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1429706 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1443166 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 30619195 | TotalRevenuePriorYear |
| Total Revenue Current Year | 31404045 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 17289267 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 17104233 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 14013118 | OtherExpensePriorYear |
| Other Expenses Current Year | 15496208 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 31302385 | TotalExpensesPriorYear |
| Total Expenses Current Year | 32600441 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -683190 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -1196396 | RevenuesLessExpensesCY |
| Total Assets BOY | 23303171 | TotalAssetsBOY |
| Total Assets EOY | 20706981 | TotalAssetsEOY |
| Total Liabilities BOY | 6487350 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 5370293 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 16815821 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 15336688 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO PROVIDE, WITHIN OUR MEANS, QUALITY HEALTH CARE TO THE PEOPLE OF SOUTHEAST KENTUCKY. VALUES: THE STAFF OF PINEVILLE COMMUNITY HOSPITAL IS GUIDED BY THE FOLLOWING VALUES:A. RESPECT - WE WILL RECOGNIZE THE WORTH, DIGNITY, QUALITY AND IMPORTANCE OF EACH OTHER, THE PEOPLE WE SERVE AND THE INSTITUTION.B. QUALITY - CONTNUOUS IMPROVEMENTS IN ALL ASPECTS OF HEALTHCARE PROVIDED IS AN ATTITUDE WHICH MUST BE OUR NUMBER ONE PRIORITY.C. TEAM WORK - EACH OF US IS AN IMPORTANT PART OF THE TEAM; BY WORKING TOGETHER, OUR GOALS CAN BE ACHIEVED.D. COST EFFECTIVENESS - AN IMPORTANT DIMENSION OF QUALITY IS THE COST EFFECTIVENESS OF THE SERVICE WE OFFER; EACH OF THE TEAM MEMBERS IS COMMITTED TO THE WISE USE OF THE RESOURCES AVAILABLE.VISION: PINEIVLLE COMMUNITY HOSPITAL WILL BE PROFIDING TOP QUALITY ACUTE, OUTPATIENT, LONG TERM CARE (SNF) AND HOME HEALTH CARE WHILE MAINTAINING FINANCIAL STABILITY. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 18147414 | Expense |
| Revenue | 26995431 | Revenue |
| Description | ACUTE CARE SERVICES; THE HOSPITAL IS LOCATED IN RURAL SOUTHEAST KENTUCKY WHICH IS IN THE HEART OF THE APPALACHIAN POVERTY BELT. THE HOSPITAL IS AN APPROVED DISPROPORTIONATE SHARE HOSPITAL (DSH) THAT PROVIDES EACH YEAR MORE CARE THAN IS REQUIRED TO QUALIFY FOR THE MAXIMUM DSH LEVELS. THE HOSPITAL ALSO SERVES A HIGH PERCENTAGE OF MEDICARE AND MEDICAID PAITIENTS. THE HOSPITAL IS LICENSED FOR 120 ACUTE BEDS AND PROVIDED 12,206 DAYS OF CARE TO THE TRI-COUNTY REGION OF SOUTHEAST KY DURING THE YEAR. 7,388 DAYS OF CARE WERE PROVIDED TO MEDICARE PATIENTS (61%) AND 2,039 DAYS WERE TO MEDICAID PATIENTS (17%). THE HOSPITAL PROVIDED 631 DAYS OF CHARITY CARE DURING THE YEAR ENDED JUNE 30, 2012. THE HOSPITAL ALSO HAD 615 BAD DEBT DAYS DURING THE YEAR. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 2093924 | Expense |
| Revenue | 2644140 | Revenue |
| Description | LONG TERM CARE (SNF) UNIT - THE HOSPITAL IS LICENSED FOR 30 SKILLED BEDS. SNF PROVIDED 8,955 DAYS OF CARE TO THE TRI COUNTY ARE OF SOUTHEASTERN KY IN FYE JUNE 30, 2012. THE SNF UNIT PROVIDED 465 CHARITY CARE DAYS DURING THE YEAR. THE SNF UNIT HAD 204 BAD DEBT DAYS OF CARE DURING THE YEAR ENDED JUNE 30, 2012. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 649432 | Expense |
| Revenue | 952351 | Revenue |
| Description | HOME HEALTH AGENCY - THE HOSPITAL IS LICENSED TO SERVE BELL COUNTY. DURING THE YEAR, THE HOME HEALTH AGENCY PROVIDED 7,738 HOME HEALTH VISITS TO BELL COUNTY RESIDENTS. 386 OF THOSE VISITS WERE CHARITY CARE AND 342 WERE BAD DEBT VISITS. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 20890770 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 384 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 334 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 11 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 11 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COLAN KELLY | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 6063373051 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 850 RIVERVIEW ROAD | AddressLine1 |
| City | PINEVILLE | City |
| State | KY | State |
| ZIP Code | 409771430 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (18 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| JOHN G HOWARD | |||||||
| CHAIRMAN/DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| AUBREY BAILEY | |||||||
| VICE CHAIRMAN/DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| JOHN JONES | |||||||
| SECRETARY/DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| CHARLES BISHOP | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| MANSFIELD DIXON DMD | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| DAVID GRAMBREL | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| JERRY WOOLUM MD | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| TALMADGE HAYS MD | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| EMANUEL RADER MD | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| JOHN COMBS | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| ALBEN BROCK | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| J MILTON BROOKS | |||||||
| CEO/DIRECTOR | 40.00 | 220307 | 0 | 18469 | X | ||
| COLAN A KELLY | |||||||
| CFO | 40.00 | 98606 | 0 | 16153 | X | ||
| UYI-OGHOSA IDEMUDIA | |||||||
| DOCTOR | 40.00 | 223577 | 0 | 10899 | X | ||
| JUDY SMITH | |||||||
| CRNA | 40.00 | 187531 | 0 | 16691 | X | ||
| SHANNON SMITH | |||||||
| CRNA | 40.00 | 175209 | 0 | 9074 | X | ||
| MICHAEL PETERSON | |||||||
| DOCTOR | 40.00 | 172031 | 0 | 14210 | X | ||
| RHONDA KECK | |||||||
| CRNA | 40.00 | 152413 | 0 | 17410 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1229674 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 102906 | TotalOtherCompensation |
| Number Individuals GT100 K | 11 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| SODEXHO | |||||
| 4880 PAYSPHERE CIRCLE | CHICAGO | IL | 60674 | FOOD SERVICE | 1271604 |
| ACUTE CARE | |||||
| 1609 N ANKENY BLVD SUITE 200 | ANKENY | IA | 50023 | EMERGENCY ROOM PHYSICIANS | 533024 |
| MT REHAB PT | |||||
| 702 PHILLIPS ST | CORBIN | KY | 40701 | PHYSICAL THERAPY | 360626 |
| CPSI | |||||
| PO BOX 850309 | MOBILE | AL | 36685 | MIS VENDOR | 334192 |
| GE | |||||
| BOX 96483 | CHICHAGO | IL | 60603 | BIO-MEDICAL | 308462 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 9 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT SERVICE RE | Description |
| Business Code | 623990 | BusinessCode |
| Total Revenue Column | 29624002 | TotalRevenueColumn |
| Related Or Exempt Function Income | 29624002 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 29624002 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 336077 | TotalRevenueColumn |
| Exclusion | $336,077 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 132031 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 132031 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 132031 | TotalRevenueColumn |
| Exclusion | $132,031 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 800 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 0 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 800 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 800 | TotalRevenueColumn |
| Related Or Exempt Function Income | 800 | RelatedOrExemptFunctionIncome |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue | ExclusionExclusionAmount |
|---|---|---|---|---|---|
| PHARMACY SALES | 446110 | 1224203 | 967120 | 257083 | |
| MISCELLANEOUS | 900099 | 80172 | $80,172 | ||
| MEDICAL TRANSCRIPT | 623990 | 6760 | $6,760 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1311135 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 31404045 | TotalRevenueColumn |
| Related Or Exempt Function Income | 30591922 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 257083 | UnrelatedBusinessRevenue |
| Exclusion | $555,040 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 353535 | Total |
| Management And General | 353535 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12707675 | Total |
| Program Services | 12096952 | ProgramServices |
| Management And General | 610723 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 46107 | Total |
| Management And General | 46107 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3062679 | Total |
| Management And General | 3062679 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 934237 | Total |
| Management And General | 934237 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17838 | Total |
| Management And General | 17838 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30900 | Total |
| Management And General | 30900 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1744387 | Total |
| Program Services | 1690507 | ProgramServices |
| Management And General | 53880 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 66303 | Total |
| Management And General | 66303 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6893870 | Total |
| Program Services | 6015135 | ProgramServices |
| Management And General | 878735 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 827952 | Total |
| Management And General | 827952 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 35039 | Total |
| Program Services | 11958 | ProgramServices |
| Management And General | 23081 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 153134 | Total |
| Management And General | 153134 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1133130 | Total |
| Management And General | 1133130 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Management And GeneralManagementAndGeneral | Program ServicesProgramServices |
|---|---|---|---|
| BAD DEBTS | 2499023 | 2499023 | |
| FOOD SERVICE | 957647 | 957647 | |
| PROVIDER TAX | 575120 | 575120 | |
| MISCELLANEOUS | 318470 | 214583 | 103887 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 243395 | Total |
| Program Services | 14684 | ProgramServices |
| Management And General | 228711 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 32600441 | Total |
| Program Services | 20890770 | ProgramServices |
| Management And General | 11709671 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 262282 | BOY |
| EOY | 71073 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5347583 | BOY |
| EOY | 5402407 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 665201 | BOY |
| EOY | 626169 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 228570 | BOY |
| EOY | 247158 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 22969032 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 17061449 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6380296 | BOY |
| EOY | 5907583 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10227690 | BOY |
| EOY | 8210287 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 191549 | BOY |
| EOY | 242304 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23303171 | BOY |
| EOY | 20706981 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3411432 | BOY |
| EOY | 3309730 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3075918 | BOY |
| EOY | 2060563 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6487350 | BOY |
| EOY | 5370293 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16815821 | BOY |
| EOY | 15336688 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16815821 | BOY |
| EOY | 15336688 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23303171 | BOY |
| EOY | 20706981 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -1196396 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -282737 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 488352 | OtherCostOrOtherBasis |
| Book Value | 488352 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 10873125 | OtherCostOrOtherBasis |
| Depreciation | 8586024 | Depreciation |
| Book Value | 2287101 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 11461499 | OtherCostOrOtherBasis |
| Depreciation | 8344988 | Depreciation |
| Book Value | 3116511 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 146056 | OtherCostOrOtherBasis |
| Depreciation | 130437 | Depreciation |
| Book Value | 15619 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 5907583 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities (2 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| CASH & CD'S | 4123 | F |
| EQUITY MUTUAL FUNDS | 8206164 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 8210287 | TotalOfBookValueSecurities |
| Total Revenue | 31404045 | TotalRevenue |
| Total Expenses | 32600441 | TotalExpenses |
| Excess Or Deficit For Year | -1196396 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -282737 | NetUnrealizedGLOnInvestments |
| Total Adjustments | -282737 | TotalAdjustments |
| Excess Or Deficit Per FS | -1479133 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 31404045 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 31404045 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 31404045 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 32600441 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 32600441 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 32600441 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X: | ReturnReference |
| Explanation | THE HOSPITAL'S ACCOUNTING POLICY PROVIDES THAT A TAX EXPENSE/BENEFIT FROM AN UNCERTAIN TAX POSITION MAY BE RECOGNIZED WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING RESOLUTIONS OF ANY RELATED APPEALS OR LITIGATION PROCESSES, BASED ON THE TECHNICAL MERITS. THE HOSPITAL HAS NO UNCERTAIN TAX POSITIONS RESULTING IN AN ACCRUAL OF TAX EXPENSE OR BENEFIT. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
Discounted Other DiscountedOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Discounted Other Percentage | 100.000000000000 | DiscountedOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2143023 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 444835 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1698188 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05210 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8638144 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6294549 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2343595 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07190 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 10781167 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6739384 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4041783 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.12400 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 26500 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 26500 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00080 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 62204 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 62204 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00190 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1048807 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1048807 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03220 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 23919 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 23919 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00070 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1161430 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1161430 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03560 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 11942597 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6739384 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5203213 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.15960 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $1,429,441 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 13036588 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 14905158 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -1868570 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PINEVILLE COMMUNITY HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 850 RIVERVIEW AVE | AddressLine1 |
| City | PINEVILLE | City |
| State | KY | State |
| ZIP Code | 40977 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PINEVILLE COMMUNITY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 100.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 100.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 0 | ActionsOnNonpayment |
| Collection Activities | 1 | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Lawsuit | X | Lawsuit |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Medicare Rate | X | MedicareRate |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 5 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (5 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| PINEVILLE COMMUNITY HOSPITAL - SNF | ||||
| 850 RIVERVIEW AVE | PINEVILLE | KY | 40977 | SKILLED NURSING FACILITY |
| PINEVILLE COMMUNITY HOSPITAL - HHA | ||||
| 121 VIRGINIA AVE | PINEVILLE | KY | 40977 | HOME HEALTH AGENCY |
| PCH MEDICAL CLINIC | ||||
| 121 VIRGINIA AVE | PINEVILLE | KY | 40977 | MEDICAL CLINIC |
| PCH MEDICAL CLINIC | ||||
| HWY 119 LIGHTHOUSE MISSION | PINEVILLE | KY | 40977 | MEDICAL CLINIC |
| PCH MEDICAL CLINIC | ||||
| HWY 25E | FLATLICK | KY | 40972 | MEDICAL CLINIC |
Form990 Schedule H Part VI Form990ScheduleHPartVI (9 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| PART I, LINE 7: E - COMMUNITY HEALTH BENEFIT OPERATIONS WERE PROVIDED BASED ON ACTUAL OR ESTIMATED COSTS AS FOLLOWS: FLU SHOT CLINIC - 760 SHOTS PROVIDED AT AN ACTUAL COST OF $25 EACH, RELAY FOR LIFE - THIS IS A PROJECT THAT THE EMPLOYEES ARE VERY INVOLVED WITH EACH YEAR AND AS SUCH THE HOSPITAL PREFERS THAT THERE BE A VERY VISIBLE HOSPITAL PRESENCE IN THIS CANCER AWARENESS EVENT. THE HOSPITAL ALLOWS FOR RELAY FOR LIFE WORK TO BE DONE DURING NORMAL WORK PERIODS. EMPLOYEE HOURS SPENT ON RELAY FOR LIFE ACTIVITIES ARE ESTIMATED AND CHARGED AS COMMUNITY BENEFIT.F - COSTS ARE ACTUAL EXPENDITURES.I - COSTS ARE ACTUAL EXPENDITURES. | |
| PART III, LINE 4: THE HOSPITAL'S AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A DISCLOSURE FOR BAD DEBTS EXPENSE. BAD DEBTS EXPENSE IS RECORDED AS AN OPERATING EXPENSE. CHARITY CARE IS NOT REPORTED AS REVENUE ON THE HOSPITAL'S AUDITED FINANCIAL STATEMENTS AND THE NOTES TO THE FINANCIAL STATEMENTS INCLUDE THE AMOUNT OF CHARGES EXCLUDED FROM REVENUE. THE COST TO CHARGE RATIO (PERCENTAGE) UTILIZED FOR CALCULATING THE COST OF BAD DEBTS IS FROM WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS. THE PERCENTAGE WAS CALCULATED BY DIVIDING THE ADJUSTED PATIENT CARE COST BY THE ADJUSTED PATIENT CARE CHARGES. | |
| PART III, LINE 8: PINEVILLE COMMUNITY HOSPITAL (PCH) CONSIDERS THIS SHORTFALL AS UNREIMBURSED COST. WHILE THE SHORTFALL IN MEDICARE REIMBURSEMENT WAS MINOR, PCH TREATS PATIENTS IN THEIR COMMUNITY BASED ON MEDICAL NEED, NOT FINANCIAL RESOURCES. MEDICARE AS A PERCENTAGE OF PATIENTS SERVED REPRESENTS THE HIGHEST PERCENTAGE. BASED ON THE NEED FOR MEDICARE SERVICES PCH WILL CONTINUE TO REACH OUT TO MEDICARE PATIENTS REGARDLESS OF THE GAIN OR LOSS ON THE SERVICE SINCE THIS IS SUCH A SIGNIFICANT PORTION OF OUR COMMUNITY. THE HOSPITAL WOULD PREFER THAT THE RETURN FROM TREATING MEDICARE PATIENTS BE A GAIN, WHICH WOULD ALLOW PCH TO DO MORE FOR THEIR COMMUNITY. AS SUCH, PCH REINVESTS IN THE COMMUNITY EARNINGS FROM OPERATIONS. | |
| PART III, LINE 9B: PATIENTS WHO HAVE PREVIOUSLY QUAILIFIED FOR CHARITY CARE PRIOR TO HAVING TREATMENT ARE PRESCREENED TO SEE IF THEY STILL MEET THE CHARITY GUIDELINES. THIS CAN BE DONE PRIOR TO A TEST BEING SCHEDULED. THE PATIENT'S INCOME LEVEL, DEPENDENT STATUS AND ASSET LEVELS ARE IDENTIFIED TO INSURE THAT THE PATIENT STILL QUAILIFIES FOR CHARITY CARE. IF THE PATIENT DOES NOT QUAILIFY FOR CHARITY CARE THEN THE HOSPITAL FOLLOWS ITS NORMAL COLLECTION POLICY JUST LIKE IT WOULD FOR ANY OTHER NON-CHARITY CARE PATIENT. | |
| PART V, SECTION B, LINE 13G: PRIOR TO ANY PROCEDURE OR ADMISSION TO THE HOSPITAL (NON-EMERGENCY) PHYSICIAN OFFICES WILL SEND PATIENTS TO THE HOSPITAL CREDIT OFFICE FOR FINANCIAL ASSISTANCE. | PINEVILLE COMMUNITY HOSPITAL |
| PART VI, LINE 2: THE HOSPITAL DOES AN ANNUAL COMMUNITY BENEFIT REVIEW. WHILE THIS IS CONSIDERED A FULL COMMUNITY BENEFIT ASSESSMENT THAT THE HOSPITAL WILL BE COMPLETING IN THE FUTURE, THIS REVIEW DOES TAKE INTO CONSIDERATION THE POPULATION AGE, MORBIDITY, POVERTY LEVELS, EDUCATION STATUS AND GENERAL ECONOMIC STATUS OF THE COMMUNITY. THE PRIMARY GEOGRAPHIC AREA SERVED IS BELL CO., HARLAN CO. AND KNOX CO. THE SECONDARY MARKET AREA IS CLAY CO. AND THE TWO CONTINUOUS STATE'S THAT BORDER KENTUCKY IN THIS REGION, TENNESSEE AND VIRGINIA. THIS REGION HAS SIGNIFICANT HEALTH EXPOSURE ISSUES FOR RESIDENTS IN THIS AREA BASED ON OCCUPATION CATERGORIES AS FOLLOWS: COAL MINING - BLACK LUNG DISEASE IN EARLY STAGES AND COPD IN OLDER POPULATION; TIMBER INDUSTRY - LOGGING LEADS TO HEAVY INJURY AND DISABILITY RATE IN THE POPULATION. THIS WORK GROUP AS A WHOLE WAS FOUND TO BE VERY LOW ON EDUCATION LEVELS WITH THE NORM FOR THIS GROUP BEING LESS THAN A HIGH SCHOOL EDUCATION. THE OVERALL GENERAL POPULATION AS A GROUP HAS A VERY HIGH HEALTH RISK EXPOSURE FROM THE PREVALENCE OF TOBACCO USE, ORAL AND SMOKING, IS SIGNIFICANTLY HIGH; PLUS, THE OVERALL INCREASE IN THE AGING OF THE GENERAL POPULATION AND THE NEED FOR ADDITIONAL HEALTHCARE SERVICES IS A MAJOR FACTOR. | |
| PART VI, LINE 3: THE HOSPITAL INFORMS THE GENERAL POPULATION CONCERNING THE CHARITY CARE POLICY THROUGH THE GENERAL ADMISSION SCREENING PROCESS AND A SUMMARY OF THE CHARITY CARE FUNCTION IS IN ALL AREA'S OF THE HOSPITAL THAT HAVE PATIENT CARE REGISTRATION FUNCTION OR CONTACT. HOSPITAL EMPLOYEES ARE EDUCATED TO MAKE PATIENTS AWARE OF THE HOSPITAL'S CHARITY CARE POLICY AND HOW IT APPLIES TO EACH PATIENT AND WHERE PATIENTS CAN GO FOR ADDITIONAL INFORMATION OR EDUCATION ON THE HOSPITAL'S CHARITY CARE POLICY. ALL PHYSICIAN OFFICES IN THE GENERAL AREA OF THE HOSPITAL ARE FULLY AWARE OF THE HOSPITAL'S CHARITY CARE POLICY AND DIRECT PATIENTS TO THE HOSPITAL. | |
| PART VI, LINE 4: PINEVILLE HOSPITAL'S PRIMARY MARKET AREA IS IN THE HEART OF EASTERN APPALACHIA COMPRISED OF BELL CO., HARLAN CO. AND KNOX CO. THE HOSPITAL'S SECONDARY MARKET AREA IS COMPRISED OF CLAY CO. AND THE TWO CONTINUOUS STATE'S THAT BORDER KENTUCKY, TENNESSEE AND VIRGINIA. | |
| PART VI, LINE 5: PINEVILLE COMMUNITY HOSPITAL IS QUITE INVOLVED IN THE COMMUNITY THAT IT SERVES. THE HOSPITAL HAS AN OPEN MEDICAL STAFF THAT IS OPEN TO ALL QUALIFIED PHYSICIANS. THE MEDICAL STAFF OF THE HOSPITAL DOES NOT SOLELY LIVE IN ONE COMMUNITY BUT RESIDES IN OUTLAYING COMMUNITIES AS WELL. THE HOSPITAL'S MANAGING BOARD ARE ALL RESIDENTS OF THE HOSPITAL'S PRIMARY MARKET AREA. THEY LIVE, WORK, AND WORSHIP WITH THE COMMUNITY THAT THE HOSPITAL SERVICES. AS SUCH, THEY SEE AND HEAR THE NEEDS OF THE HOSPITAL'S MARKET AREA. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | X | IndependentConsultant |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 1 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| J MILTON BROOKS | |||||||||||||
| 198307 | 0 | 0 | 0 | 22000 | 0 | 4259 | 0 | 14210 | 0 | 238776 | 0 | 0 | 0 |
| UYI-OGHOSA IDEMUDIA | |||||||||||||
| 207397 | 0 | 0 | 0 | 16180 | 0 | 4426 | 0 | 6473 | 0 | 234476 | 0 | 0 | 0 |
| JUDY SMITH | |||||||||||||
| 177131 | 0 | 0 | 0 | 10400 | 0 | 3590 | 0 | 13101 | 0 | 204222 | 0 | 0 | 0 |
| SHANNON SMITH | |||||||||||||
| 159143 | 0 | 0 | 0 | 16066 | 0 | 1928 | 0 | 7146 | 0 | 184283 | 0 | 0 | 0 |
| MICHAEL PETERSON | |||||||||||||
| 172031 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 14210 | 0 | 186241 | 0 | 0 | 0 |
| RHONDA KECK | |||||||||||||
| 136547 | 0 | 0 | 0 | 15866 | 0 | 3200 | 0 | 14210 | 0 | 169823 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 4B | MR. BROOKS PARTICIPATES IN A NONQUALIFIED RETIREMENT PLAN PAID FOR BY THE HOSPITAL. FOR FYE JUNE 30, 2012 THE HOSPITAL CONTRIBUTED $0 TO THE PLAN. |
| PART I, LINE 6 | TO BETTER SERVE THE NEEDS OF THE TRI-COUNTY AREA, IN 2008, THE HOSPITAL BEGAN HIRING PHYSICIAN EMPLOYEES. IN FULFILLMENT OF THE TERMS OF THEIR EMPLOYMENT CONTRACTS, DOCTORS CAN RECEIVE INCENTIVE PAY CALCULATED AS A PERCENTAGE OF THE NET PROFITS OF THE MEDICAL PRACTICE SERVICES THEY PROVIDE. DURING THE CURRENT YEAR NO BONUSES WERE ISSUED. |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | H AUBREY BAILEY | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | DIRECTOR | Relationship |
| Description Of Transaction | MR. BAILEY SERVES ON THE BOARD OF THE HOSPITAL AND ALSO SERVES ON THE BOARD OF FIRST STATE FINANCIAL, A BANK THAT THE HOSPITAL HAS AN ONGOING BUSINESS RELATIONSHIP WITH. | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | THERE ARE TWO MEMBERS OF THE BOARD OF DIRECTORS THAT ARE DIRECTLY RELATED IN AN EMPLOYER - EMPLOYEE RELATIONSHIP. MR. JOHN HOWARD IS THE OFFICE MANAGER OF DR. TALMADGE HAYS OFFICE PRACTICE. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORMS 990 AND 990-T ARE REVIEWED BY THE OFFICERS OF THE COMPANY FOR COMPLETENESS AND ACCURACY. PRIOR TO FILING THE FORMS 990 AND 990-T THEY ARE PRESENTED TO THE BOARD FOR REVIEW AND DISCUSSION. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CHAIRMAN OF THE BOARD MAKES EACH BOARD MEMBER AWARE OF THEIR RESPONSIBILITIES AS IT RELATES TO THE COMPLETION OF THE CONFLICT OF INTEREST STATEMENT. EACH BOARD MEMBER IS GIVEN A PACKET CONTAINING THE STATEMENT TO BE SIGNED. THE CHAIRMAN IS RESPONSIBLE TO ENSURE THAT ALL STATEMENTS ARE SIGNED AND RETURNED. | |
| FORM 990, PART VI, SECTION B, LINE 15A | ANNUALLY, EACH MEMBER OF THE BOARD OF DIRECTORS CREATE A WRITTEN EVALUATION OF THE CEO. THE INDIVIDUAL EVALUATIONS ARE COMPLIED INTO ONE PACKAGE PRIOR TO MEETING WITH THE CEO TO DISCUSS THE EVALUATION. AT THE MEETING GOALS ARE ESTABLISHED. COMPENSATION IS SET AT THE MEETING. THE BOARD MAY USE OUTSIDE ENTITIES TO DETEREMINE IF THE COMPENATION PACKAGE IS ADEQUATE / INADEQUATE. THE PRIMARY ADJUSTMENTS HAVE BEEN INCREASES DUE TO THE COST OF LIVING INCREASING. | |
| FORM 990, PART VI, SECTION C, LINE 18 | THE 990 AND 990-T ARE AVAILABLE THROUGH WWW.GUIDESTAR.ORG AND BY REQUEST. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE GOVERNING DOCUMENTS, CONFLICT OF INTERTEST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST. THE HOSPITAL PUBLISHES ANNUAL FINANCIAL OUTCOMES IN THE HOSPITAL NEWSLETTER WHICH IS MAILED TO MOST OF THE MARKET AREA SERVED BY THE HOSPITAL. COPIES OF THE NEWSLETTER ARE DISTRIBUTED TO PATIENTS, FAMILIES AND VISITORS TO THE HOSPITAL. ALSO, FINANCIAL STATEMENTS ARE POSTED WITH THE CREDIT AGENCY DUNN & BRADSTREET FOR COMMERCIAL USERS. | |
| FORM 990, PART VII | JOHN G. HOWARD - 111 PAULA DRIVE, PINEVILLE, KY 40977. AUBREY BAILEY - 103 KINGSBURY HEIGHTS, MIDDLESBORO, KY 40965. JOHN JONES - 145 HORSESHOE DR, PINEVILLE, KY 40977. CHARLES BISHOP - 133 WOODLAND TR, PINEVILLE, KY 40977. MANSFIELD DIXON, DMD - 121 VIRGINIA AVE, PINEVILLE, KY 40977. DAVID GRAMBREL - 113 RIDGEWOOD CIRCLE, PINEVILLE, KY 40977. JERRY WOOLUM, MD - 121 VIRGINIA AVENUE, PINEVILLE, KY 40977. TALMADGE HAYS, MD - 121 VIRGINIA AVENUE, PINEVILLE, KY 40977. EMANUEL RADER, MD - P.O. BOX 70, PINEVILLE, KY 40977. JOHN COMBS - PO BOX 573, PINEVILLE, KY 40977. ALBEN BROCK - PO BOX 339, PINEVILLE, KY 40977. | CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC |
| FORM 990, PART XI, LINE 5: | NET UNREALIZED LOSSES ON INVESTMENTS: -282,737. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XI, 2C, SELECTION AND OVERSIGHT OF INDEPENDENT ACCOUNTANT: | THE BOARD OF DIRECTORS IS RESPONSIBLE FOR THE SELECTION AND OVERSIGHT OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. | |
| SCH H, PART V, NUMBER AND TYPES OF OTHER HEALTH CARE FACILITIES: | 2 MEDICAL CLINICS |