2011-01-18T20:36:38-07:00 2010-02-28 990 2009-03-01 310949874 MONROE MEDICAL FOUNDATION INC MONR 2704879231 529 CAPP HARLAN ROAD TOMPKINSVILLE KY 42167 Rickie Brown 2704879231 2011-01-18 2009 2016-02-24 21:20:13Z Monroe County Medical Center Greg Crabtree DMD 529 Capp Harlan Road Tompkinsville KY 42167 20664127 0 X www.mcmccares.com X 1979 KY ACUTE CARE HOSPITAL - Our mission is to be a rural healthcare organization who values compassion, respect and confidentiality, and provide quality, safe primary and specialty services for the citizens of Monroe County and surrounding area through detection prevention and treatment of illness. We achieve this by operating a 49 bed acute care hospital, ambulance service, home health agency, HCB Waiver program, physician office and county 911 service. 9 7 277 0 0 0 475274 468631 18608827 20089033 209318 82407 36698 24056 19330117 20664127 12625 31249 0 0 9774724 10442469 0 0 0 8257666 8725402 18045015 19199120 1285102 1465007 21962433 23012332 1839015 1423907 20123418 21588425 ACUTE CARE HOSPITAL - The mission of the Monroe Medical Foundation, Inc. is to be a rural healthcare organization who values compassion, respect and confidentiality, and provides quality, safe, primary and specialty services for the citizens of Monroe County and surrounding area through detection prevention and 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. 0 0 16586124 12625 20089033 Inpatient Care - Monroe Medical Foundation, Inc. operates a 49 bed acute care general hospital. The hospital admitted 2,365 patients, treated 7,968 patients in the emergency room, treated 21,182 patients as outpatient referrals and made 1,888 ambulance runs in FYE 02-28-10. The hospital also operates a home health agency which made 1,561 skilled nurse visits, 6,674 home health aide visits, 1,370 physical therapy visits, 47 speech therapy visits and 16 social worker visits. This home health agency also operates a HCB Waiver Program which did 3,183 homemaker units, 459 case management units, 134 respite units, 18 assessments and 27 reassessments during the fiscal year. The patients admitted to the hospital consisted of approximately 51% Medicare patients and 23 % Medicaid patients. Approximately 9% of patients admitted did not have Medicare or Medicaid and did not have any type of insurance. (6 high school graduates attending college). 0 0 0 16586124 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 18 0 1 277 1 0 0 0 0 0 9 7 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X Monroe County Medical Center 2704879231 529 Capp Harlan Road Tompkinsville KY 42167 Judy Rowland 1 X X 0 0 0 Fowler Ross JR OD 1 X 0 0 0 Jimmy Goodman 1 X 0 0 0 Johnny Travis 1 X 0 0 0 Timothy Hume MD 1 X 0 0 0 Polly Baker 1 X 0 0 0 Gene Hagan 1 X 0 0 0 Jerry Bean MD 1 X 0 0 0 Greg Crabtree DMD 1 X X 0 0 0 Kimberly Eakle-Hume M D 7 X 27080 0 0 Vicky McFall 40 X 0 0 0 Rickie Brown 40 X 0 0 0 Deborah Bentley 40 X 130109 0 0 Andrea McAlpin 40 X 122614 0 0 Clella Hays MD 40 X 165000 0 0 444803 0 0 3 0 1 0 Quorum Health Resources LLC 105 Continental Place Brentwood TN 37027 Management Contract & Provides CEO and CFO 597196 Batten & Shaw Inc 107 Music City Circle Nashville TN 37214 Construction General Contractor 596177 Inspire Medical Inc 2323 Lime Kiln Lane Louisville KY 40222 Emergency Room Physicians 1139254 CPSI 6600 Wall St Mobile AL 36695 Computer Software and Maintenance 171080 4 0 0 0 0 468631 0 0 468631 Hospital services net of contractual adjustments and charity 622000 20089033 20089033 0 0 0 0 0 0 20089033 82407 0 0 82407 0 0 0 0 0 0 0 0 22725 0 0 0 22725 0 22725 22725 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1331 1331 0 0 1331 20664127 20113089 0 82407 0 0 31249 31249 0 0 0 0 0 0 0 0 0 0 0 0 8703640 7881833 821807 0 125576 113719 11857 0 956757 866419 90338 0 656496 594509 61987 0 592146 0 592146 0 1773 0 1773 0 22608 0 22608 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11035 11035 0 0 2652442 2481384 171058 0 153339 0 153339 0 0 0 0 0 422239 0 422239 0 104716 93813 10903 0 0 0 0 0 10619 8763 1856 0 0 0 0 0 0 0 0 0 1398686 1361679 37007 0 148582 146766 1816 Provision for Bad Debts 726087 726087 0 0 Physician Fees 1188866 1188866 0 0 Other Expenses 489666 287326 202340 0 Equipment Repairs & Maintenance 482661 472739 9922 0 Kentucky Provider Tax 319937 319937 0 0 19199120 16586124 2612996 0 5198 7397 2006357 880848 0 0 2216051 4008073 0 0 0 0 0 0 299466 334368 199905 222372 28735660 14601743 13983094 14133917 0 0 0 0 3252362 3425357 21962433 23012332 1666164 1029786 0 0 0 0 0 0 0 0 0 0 0 0 0 172851 394121 1839015 1423907 X 19899722 21407713 223696 180712 0 0 20123418 21588425 21962433 23012332 X 0 1 1 0 X 0 412789 412789 0 12047945 3339057 8708888 0 0 0 0 0 16274926 11262686 5012240 0 0 0 0 14133917 Funded Depreciation Restricted 2731475 Cash Restricted for Adult Daycare 16763 Other Receivables 669744 Other Assets 7375 3425357 Medicare & Medicaid Settlements 394121 394121 20664127 19199120 1465007 0 0 0 0 0 0 1465007 20664127 0 0 0 0 0 20664127 0 0 0 20664127 19199120 0 0 0 0 0 19199120 0 0 0 19199120 SchD_P10_S00_L00 Schedule D, Part X We do not have any uncertain tax prositions under Fin 48. The $394,121 liability is for Medicare and Medicaid settlements. 1 1 1 X 1 X 1 1 1 0 0 1275040 395760 879280 0.0458 2928425 1906262 1022163 0.0532 0 0 0 0.0 0 0 4203465 2302022 1901443 0.0990 12790 0 12790 0.0007 5000 0 5000 0.0003 1040922 864611 176311 0.0092 0 0 0 0 0 0 0 0 0 0 1058712 864611 194101 0.0102 0 0 5262177 3166633 2095544 0.1092 1 341261 61544 9758882 8105103 1653779 X 1 1 Quorum Health Resources LLC Management Company 0 0 0 Monroe County Medical Center

529 Capp Harlan Road Tompkinsville KY 42167

X X X Monroe County Home Health Agency

417 Capp Harlan Road Tompkinsville KY 42167

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

417 Capp Harlan Road Tompkinsville KY 42167

Provides Adult Daycare Services Ratio of Patient Care Cost to Charges was used as the costing methodology. There were no costs attributable to a physician clinic included as subsidized health services in line 7(g). Bad debt expense at cost of $21,708 was removed and Charity Care expense at cost of $60,848 was removed from this figure for purposes of calculating the percentage in Schedule H, Part I, Line 7, column (f). The costing methodology used to determine the amounts reported is based on the Ratio of Patient Care Cost to Charges applied to the gross amounts written off as bad debts. There is no shortfall on Medicare. The costing methology used is the Ratio of Patient Care Cost to Charges applied to the gross charges. Upon registration financial information is gathered when possible to determine if they qualify for charity or financial assistance. If they are not able to provide the information at that time they are given a financial information form to complete later. If they are admitted to the hospital, the patient financial counseler goes to the patient room and discusses the charity and financial assistance information with the patient. If we are unable to obtain the necessary information from the patient at that time, we send the information to a contracted company to obtain the necessary information and assist them in obtaining the information and financial assistance they qualify for. Hospital 1 Home Health Agency 1 Adult Daycare 1 The needs assessment has been developed in connection with teh Monroe County Health Department. Information is provided at registration. Patient Financial Counseler discusses the financial assistance information with the inpatients and information is mailed to the outpatients. Also, a contracted company contacts the patients if the information is not obtained while in the hospital. The hospital is located in Monroe County, Kentucky which is a very rural area. The hospital has a service area of approximately 18,000 population. The population is approximately 11,000 in our county. The poverty level is 20.2% compared to 12.5% nationwide. The unemployment for Monroe County is 10.3% compared to the state percentage of 9.9%. The individuals with a high school education or higher is 65% in this county compared to 74% for Kentucky and 74% nationwide. More than 50% of the people surveyed stated that transportation is the biggest barrier to healthcare. We have an open medical staff. Our county is considered a HPSA (Health Professional Shortage Area). We have a very large amount of the population which is below the poverty level. All surplus funds of the hospital are used to purchase updated equipment, improve the building and normal operating expenses to continue to provide wellness services and quality healthcare for our community. n/a 1 High School Senior Scholarships 5 5000 Nursing School assistance for RN students and LPN students 2 18202 0 Pharmacist Tuition Assistance 1 8046 0 SchI_P01_S00_L02 Schedule I, Part I, Line 2 The Grants Funds or assistance is monitored by the CEO, CFO and the Board of Directors. The Board of Directors approves the Grants or other assistance for education, etc.. The individuals are required to provide proof of enrollment, etc. and appropriate grades to receive the grants or assistance. X 0 0 0 0 0 0 0 0 0 Clella Hays MD 165000 0 0 0 0 0 0 0 3324 0 168324 0 SchJ_P02_S00_L00 Schedule J, Part II Compensation paid to Vicky McFall, CEO and Rickie Brown, CFO was paid by Quorum Resources LLC which is the management company Gene Hagan Board Member 9303 Purchase of supplies and construction project 0 Johnny Travis Board Member 4811 Purchase of supplies and construction project 0 Terry L Carter Daughter of Board Member 64186 Employee wages for registered nurse 0 Jo Ann Brown Spouse of CFO 63755 Employee wages for registered nurse 0 Emily J Brown Daughter of CFO 39007 Employee wages for registered nurse 0 F990_P03_S00_L01 Form 990, Part III, Line 1 The Monroe County Medical Center operates the ambulance service for the county. F990_P06_S0A_L03 Form 990, Part VI, Section A, Line 3 The Monroe Medical Foundation, Inc. has contracted with a management company, Quorum Health Resources, LLC to provide management services to the 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_L11 Form 990, Part VI, Section B, Line 11 The Form 990 is prepared by the CFO and is reviewed with the CEO before it is filed. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c Each member of the Board of Directors and the CEO and CFO completes a conflict of interest questionaire annually. Anytime there is a conflict of interest with any Board Member on any issue being discussed by the Board of Directors, the Board member who has the conflict abstains from any vote on the issue. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 The process for determining compensation of the CEO and CFO includes a review and approval by Quorum Health Resources, LLC., the management company , and the Board of Directors. Each member of the Board of Directors completes an evaluation of the CEO, and submits it to the Quorum Regional Vice President. The Regional Vice President presents the evaluations and his recommendations to the Board of Directors based on the evaluations and the salary scale of the management company. The Board of Directors approves or disapproves the recommendation of the Quorum Regional Vice President. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 The governing documents, conflict of interest policy, and financial statements are available to the public upon request in the Administrative office of the Monroe County Medical Center, 529 Capp Harlan Road, Tompkinsville, Kentucky 42167.