2026-05-15T13:39:55-05:00 2025-06-30 390859910 BAKER TILLY ADVISORY GROUP LP 1570 FRUITVILLE PIKE SUITE 400 LANCASTER PA 17601 990 2024-07-01 453215312 PORTSMOUTH HOSPITAL CORPORATION PORT 7409914000 1901 ARGONNE AVENUE PORTSMOUTH OH 45662 SARA MARKS PRESIDENT 7409914000 2026-05-14 1 1 KERRI N BOGDA P00760402 7177404863 2026-05-14 2024 2025-03-06 01:10:19Z KING'S DAUGHTERS MEDICAL CENTER OHIO SARA MARKS 2201 LEXINGTON AVENUE ASHLAND KY 41101 39512078 0 X WWW.KINGSDAUGHTERSHEALTH.COM/LOCATIONS X 2010 OH TO CARE. TO SERVE. TO HEAL. 10 10 268 11 0 0 2959 4000 30214263 39508078 20010 0 0 0 30237232 39512078 12320 30840 0 0 15202530 17203266 0 0 0 14254212 16121048 29469062 33355154 768170 6156924 28891175 28128429 3119868 3239420 25771307 24889009 X KING'S DAUGHTERS MEDICAL CENTER OHIO IS LOCATED IN THE HISTORIC TOWN OF PORTSMOUTH, OH AT THE CONFLUENCE OF THE OHIO, SCIOTO, AND LITTLE SCIOTO RIVERS. WE HAVE BEEN SPECIFICALLY DESIGNED TO MEET THE HEALTHCARE NEEDS OF THE COMMUNITY. CONTINUED ON SCHEDULE O.OUR PRIMARY SERVICE AREA IS THE COUNTY OF SCIOTO. ADDITIONAL COUNTIES WE SERVE ARE LAWRENCE, ADAMS, AND JACKSON IN OHIO AND GREENUP AND LEWIS IN KENTUCKY. 0 0 29258122 30840 39508078 FOR 13 YEARS, KING'S DAUGHTERS MEDICAL CENTER OHIO (KDOH, PORTSMOUTH HOSPITAL CORP.) HAS PROVIDED RESIDENTS OF SCIOTO, PIKE, AND LAWRENCE COUNTIES IN OHIO AND GREENUP COUNTY, KENTUCKY, WITH ACCESS TO HIGH-QUALITY LOCAL HEALTHCARE. LICENSED FOR 10 INPATIENT BEDS, KDOH OFFERS A COMFORTABLE, QUIET, AND PATIENT-FOCUSED HEALING ENVIRONMENT DESIGNED TO MEET THE NEEDS OF THESE COMMUNITIES. KDOH PROVIDES ACCESS TO ADVANCED TECHNOLOGY AND SPECIALTY SERVICES NOT TYPICALLY AVAILABLE IN HOSPITALS OF SIMILAR SIZE. SURGICAL AND PROCEDURAL SERVICES INCLUDE ANESTHESIOLOGY, GASTROENTEROLOGY, GENERAL SURGERY, GYNECOLOGY, INTERVENTIONAL PAIN MANAGEMENT, OPHTHALMOLOGY, ORTHOPEDICS, OTOLARYNGOLOGY, PLASTIC AND RECONSTRUCTIVE SURGERY, UROLOGY, AND VASCULAR SURGERY. MEDICAL SPECIALTIES INCLUDE CARDIOLOGY, DERMATOLOGY, ELECTROPHYSIOLOGY, NEPHROLOGY, PEDIATRICS, PRIMARY CARE, PSYCHIATRY, PULMONOLOGY, RHEUMATOLOGY, AND URGENT CARE.DIAGNOSTIC AND TREATMENT SERVICES INCLUDE CARDIOVASCULAR (HEART FAILURE CLINIC, ANTICOAGULATION CLINIC, STRESS TESTING, ECHOCARDIOGRAMS, ELECTROCARDIOGRAMS, AND CALCIUM SCORE SCREENINGS); IMAGING (CT, MRI, 3D MAMMOGRAPHY, X-RAY, NUCLEAR MEDICINE, AND GENERAL AND VASCULAR ULTRASOUND); INPATIENT OBSERVATION, PRE- AND POST-OPERATIVE CARE; LABORATORY TESTING, INCLUDING A DRIVE-THROUGH LABORATORY; NEURODIAGNOSTICS (ELECTROMYOGRAPHY AND EPILEPSY MONITORING); NUTRITION AND DIABETES COUNSELING; PULMONARY AND RESPIRATORY SERVICES (PULMONARY FUNCTION TESTING AND SLEEP LABORATORY); AND SOCIAL WORK SERVICES.IN ADDITION TO PROVIDING HIGH-QUALITY CARE CLOSE TO HOME, KDOH CONNECTS PATIENTS TO ADVANCED SPECIALTY SERVICES AVAILABLE AT UK KING'S DAUGHTERS IN ASHLAND, KENTUCKY, AND TO TERTIARY AND QUATERNARY CARE AT THE UNIVERSITY OF KENTUCKY HEALTHCARE IN LEXINGTON.KDOH RECOGNIZES COMMUNITY INVOLVEMENT AS ESSENTIAL TO IMPROVING HEALTH OUTCOMES AND SUPPORTING COMMUNITY GROWTH. THE HOSPITAL PROVIDES FREE HEALTH SCREENINGS AND EDUCATION FOCUSED ON HEART AND VASCULAR HEALTH, DIABETES, SKIN CANCER, PROSTATE CANCER, AND JOINT HEALTH. RESIDENTS ALSO BENEFIT FROM A LOW-COST BLOOD PROFILE PROGRAM THAT SUPPORTS EARLY DETECTION AND MONITORING OF CONDITIONS SUCH AS DIABETES AND CARDIOVASCULAR DISEASE THROUGH TESTING OF A1C, LIPID LEVELS, AND OTHER KEY LABORATORY VALUES.KDOH ACTIVELY PARTICIPATES IN COMMUNITY EVENTS AND PARTNERS WITH LOCAL ORGANIZATIONS, INCLUDING CIVIC ORGANIZATIONS (ROTARY, KIWANIS, AND LIONS CLUB); FIRST RESPONDER AGENCIES, INCLUDING PAID AND VOLUNTEER EMS SQUADS; CITY AND COUNTY HEALTH DEPARTMENTS; SHAWNEE STATE UNIVERSITY; AND LOCAL FARMERS MARKETS, INCLUDING SUPPORT FOR THE KIDS MOBILE FARMERS MARKET PROGRAM, WHICH PROMOTES NUTRITION EDUCATION AND ACCESS TO FRESH PRODUCE FOR CHILDREN.ADDITIONAL COMMUNITY SUPPORT INCLUDES BACK-TO-SCHOOL PROGRAMS PROVIDING SCHOOL SUPPLIES, SHOES, COATS, AND CLOTHING AND ATHLETIC TRAINING SERVICES FOR AREA SCHOOLS DURING PRACTICES AND COMPETITIONS.BY COMBINING HIGH-QUALITY CLINICAL CARE WITH EXTENSIVE COMMUNITY OUTREACH, KING'S DAUGHTERS MEDICAL CENTER OHIO REMAINS COMMITTED TO IMPROVING HEALTH OUTCOMES AND STRENGTHENING THE COMMUNITIES IT SERVES. 29258122 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 0 0 268 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 OH X LAURIE STEWART CONTROLLER 6064089640 2201 LEXINGTON AVENUE ASHLAND KY 41101 DAVID JONES CHAIRMAN, BOARD OF DIRECTOR 0.25 4.00 X X 0 0 0 MARK BIRDWHISTELL BOARD OF DIRECTORS 0.25 2.25 X 0 0 0 CRAIG COLLINS BOARD OF DIRECTORS 0.25 2.25 X 0 0 0 ERIC MONDAY BOARD OF DIRECTORS 0.25 2.25 X 0 0 0 STEPHEN ADDINGTON BOARD OF DIRECTORS 0.25 2.50 X 0 0 0 TOM BURNETTE BOARD OF DIRECTORS 0.25 2.50 X 0 0 0 JOHN STEWART BOARD OF DIRECTORS 0.25 2.50 X 0 0 0 ROBERT DIPAOLA BOARD OF DIRECTORS 0.25 2.25 X 0 0 0 GINA DUGAS BOARD OF DIRECTORS 0.25 2.25 X 0 0 0 PENNY COX BOARD OF DIRECTORS 0.25 2.25 X 0 0 0 STEVEN CLIFTON SECRETARY 0.25 4.00 X 0 0 0 AUTUMN MCFANN TREASURER 1.25 60.25 X 0 1017721 137762 SARA MARKS PRESIDENT/CEO 1.25 60.25 X 0 1057903 138206 AMY SAUNDERS ASSISTANT SECRETARY 0.25 44.00 X 0 262208 27466 ROY ADAMS PHC MEDICAL DIRECTOR, PHYSICIAN 0.25 40.00 X 1188 163565 30664 JAMES NEAL CNO/ADMINISTRATOR 45.00 0.00 X 151481 0 18598 CANDICE TACKETT EXECUTIVE DIRECTOR (UNTIL 10/25) 45.00 0.00 X 163716 0 25340 MELISSA MURRAY-KLINE OR NURSE LEADER 40.00 0.00 X 112745 0 17008 CHARLES L CONLEY PHYSICIAN 10.00 42.00 X 162463 521958 48862 TONY VIRGIN PHYSICIAN 19.50 40.00 X 155081 594738 44692 CRAIG HAZELBAKER PHARMACIST / PHARMACY SUPERVISOR 40.00 0.00 X 176832 0 29299 MELISSA WATSON PHARMACIST 40.00 0.00 X 166936 23 28427 1090442 3618116 546324 9 0 1 0 WHISKEY TANGO CREATIVE GROUP PO BOX 5185 ASHLAND KY 411055185 MARKETING SERVICES 151500 BAYMARK MANAGEMENT SERVICES DEPT D8126 PO BOX 650002 DALLAS TX 75265 ADDICTION RECOVERY SERVICES 127642 2 4000 4000 NET PATIENT REVENUE 621110 39268078 39268078 PHARMACY REVENUE 621110 240000 240000 39508078 39512078 39508078 0 0 30840 30840 385351 385351 12596471 11039547 1556924 330752 289871 40881 2995586 2625332 370254 895106 776146 118960 241740 241740 1181 1181 2633348 2551180 82168 284011 284011 567494 416008 151486 610133 610133 13072 12695 377 31243 31243 1926565 1926565 15771 15771 MEDICAL SUPPLIES 4801862 4749785 52077 BAD DEBT EXPENSE 3476034 3476034 REPAIRS AND MAINTENANCE 1338343 1206053 132290 MINOR EQUIPMENT 64130 55817 8313 116121 101068 15053 33355154 29258122 4097032 0 431845 4142 3287744 3965114 1134843 1202669 161996 238720 27203337 4485553 23874747 22717784 28891175 28128429 1865253 1822494 1254615 1416926 3119868 3239420 X 25771307 24889009 25771307 24889009 28891175 28128429 X 6156924 -7039222 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 1181 1181 0 PART II-B, LINE 1: $995: A PORTION OF DUES PAID TO THE OHIO HOSPITAL ASSOCIATION ATTRIBUTABLE TO LOBBYING EXPENSES. $186: A PORTION OF DUES PAID TO 340B HEALTH ATTRIBUTABLE TO LOBBYING EXPENSES 605910 605910 19049920 1309545 17740375 5250 5250 0 6942257 3103432 3838825 600000 67326 532674 22717784 DUE TO MEDICARE 1416926 1416926 1 1 X 1 X 1 X 1 1 1 0 1 1 129438 129438 0.00430 9794274 11847391 0 0.00000 9923712 11847391 129438 0.00430 72285 72285 0.00240 52325 52325 0.00180 124610 124610 0.00420 10048322 11847391 254048 0.00850 1 1007323 32701 3639488 4056728 -417240 X 1 1 1 1 PORTSMOUTH HOSPITAL CORPORATION 1901 ARGONNE RD PORTSMOUTH OH 45662 WWW.KDMCOHIO.COM X X X URGENT CARE - 24 HOURS PORTSMOUTH HOSPITAL CORP DBA KDMC OHIO 1 0 0 1 X X X X X X X X X 24 1 1 1 1 X KINGSDAUGHTERSHEALTH.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS/ X 1 25 1 KINGSDAUGHTERSHEALTH.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS/ 0 1 X 200.000000000000 300.000000000000 X X X X 1 1 X X X 1 X KINGSDAUGHTERSHEALTH.COM/PATIENT-VISITORS/FINANCIAL-SERVICES-RESOURCES X KINGSDAUGHTERSHEALTH.COM/PATIENT-VISITORS/FINANCIAL-SERVICES-RESOURCES X KINGSDAUGHTERSHEALTH.COM/PATIENT-VISITORS/FINANCIAL-SERVICES-RESOURCES X X X X X 1 X 0 X X X X 1 X 0 1 PORTSMOUTH HOSPITAL CORP DBA KDMC OHIO PART V, SECTION B, LINE 5: THE PRC PROCESS WORKED TO ASSURE THAT THERE WAS A BROAD INVOLVEMENT FROM THE COMMUNITY IN THE ASSESSMENT PROCESS THROUGH THE USE OF THE KEY INFORMANT AND COMMUNITY SURVEYS. THE KEY INFORMANT SURVEY INCLUDED INDIVIDUALS FROM PUBLIC HEALTH, BUSINESS, NON-PROFITS, HEALTHCARE AND OTHERS INTERESTED IN THE HEALTH OF THEIR COMMUNITY. PORTSMOUTH HOSPITAL CORP DBA KDMC OHIO PART V, SECTION B, LINE 6A: SOUTHERN OHIO MEDICAL CENTER (SOMC) PORTSMOUTH HOSPITAL CORP DBA KDMC OHIO PART V, SECTION B, LINE 6B: SCIOTO COUNTY HEALTH DEPARTMENTPORTSMOUTH CITY HEALTH DEPARTMENT PORTSMOUTH HOSPITAL CORP DBA KDMC OHIO PART V, SECTION B, LINE 11: THE 2024-2025 COMMUNITY HEALTH NEED ASSESSMENT IDENTIFIED THE FOLLOWING NEEDS THAT THE MEDICAL CENTER WILL BE ADDRESSING:THE PRIORITIES IDENTIFIED BY THE CHNA AND RATIFIED BY THE KDOH LEADERSHIP TEAM ARE:- PREVENTIVE HEALTH AND EDUCATION- ACCESS TO HEALTH SERVICES/NAVIGATING HEALTHCARE SERVICES- CHRONIC HEALTH CONDITIONS (HIGH BLOOD PRESSURE, DIABETES, HEART DISEASE, CANCER, CHRONIC PAIN.- FOOD INSECURITY/LACK OF HEALTHY NUTRITION- OBESITY- PHYSICAL INACTIVITY- SENIOR SERVICES- SMOKING/VAPING- MONETARY SPONSORSHIPS TO COMMUNITY-BASED ORGANIZATIONS. - MENTAL HEALTH/SUBSTANCE USE DISORDER- SUICIDE PREVENTION AND MENTAL HEALTH AWARENESS. - MENTAL HEALTH RESOURCES/PROGRAMING IN THE COMMUNITY- TRANSPORTATION- EVALUATE KDOH AND THE SURROUNDING COMMUNITIES' TRANSPORTATION SYSTEMS AND IDENTIFY GAPS AND OPPORTUNITIES. DEVELOP A COMPREHENSIVE PLAN TO MAXIMIZE EFFICIENCIES AND EXPAND SERVICES WHERE FEASIBLE WITH POTENTIAL SOLUTIONS FOR RELIABLE TRANSPORTATION IN THE COMMUNITY.DESCRIBE ANY NEEDS THAT ARE NOT BEING ADDRESSED, AND THE REASONS WHY THE NEEDS ARE NOT BEING ADDRESSED.- CHILDCARE- THIS IS OUT OF OUR SCOPE OF WORK- POVERTY- KDOH ADDRESS THIS THROUGH OUR SPONSORSHIPS OF ORGANIZATIONS FOCUSED ON THOSE LIVING IN POVERTY BY HELPING THEM EXPAND THEIR SERVICES AND SERVE MORE CLIENTS. THE FOCUS IS ON ORGANIZATIONS PROVIDING FOOD, CLOTHING, HOUSING AND SOCIAL SERVICES. - UNINTENTIONAL INJURY- THIS IS NOT IN OUR SCOPE OF WORK.- POOR DENTAL HEALTH- THIS IS NOT IN OUR SCOPE OF WORK. PROGRESS ON ACCESS TO DENTAL CARE IS BEING ADDRESSED BY, COMMUNITY PARTNERS AND LOCAL HEALTH DEPARTMENTS. - LACK OF AFFORDABLE HOUSING-THIS IS OUTSIDE OF OUR SCOPE OF WORKIDENTIFIED NEEDS (ADDRESSED THROUGH PREVENTIVE HEALTH AND EDUCATION, MENTAL HEALTH AND SUBSTANCE USE DISORDER AND TRANSPORTATION).CHRONIC HEALTH CONDITIONSLACK OF HEALTHCARE PROVIDERSHEALTHY NUTRITIONOBESITYPHYSICAL INACTIVITYPREVENTIVE CARESMOKING/VAPINGSUBSTANCE USE DISORDERSMENTAL HEALTH SUICIDEIDENTIFIED NEEDS (ADDRESSED THROUGH KDOH'S COMPREHENSIVE SERVICES AND/OR EDUCATIONAL OUTREACH. RELATIVELY LOW PRIORITY PER COMMUNITY INPUT OBTAINED THROUGH COMMUNITY FORUMS AND COMMUNITY AND PROVIDER SURVEYS)CANCERMATERNAL INFANT AND CHILD HEALTHLOW BIRTH WEIGHTTEEN BIRTH RATENEEDS (OUTSIDE THE SCOPE OF SERVICES PROVIDED BY KDOH, BUT OPPORTUNITIES MAY EXIST FOR KDOH TO SUPPORT ORGANIZATIONS ADDRESSING THESE NEEDS)POVERTYDENTALLACK OF AFFORDABLE HOUSINGTEENAGE PREGNANCYUNINTENTIONAL INJURYFOOD INSECURITY PORTSMOUTH HOSPITAL CORP DBA KDMC OHIO PART V, SECTION B, LINE 24: FAP ELIGIBLE PATIENTS ARE CHARGED THE GROSS CHARGE FOR ANY SERVCIES EXCLUDED FROM ELIGINILITY AS DEFINED WITHIN THE FAP, WHICH ARE DEFINED AS ELECTIVE SERVES AND THEREFORE NOT MEDICALLY NECESSARY. 2 1 - PORTSMOUTH FAMILY CARE CENTER 2001 SCIOTO TRAIL SUITE 300 PORTSMOUTH OH 45662 FAMILY CARE CENTER 2 - PORTSMOUTH INTERNAL MEDICINE 2001 SCIOTO TRAIL SUITE 200 PORTSMOUTH OH 45662 INTERNAL MEDICINE PART I, LINE 7: KDOH USED WORKSHEET 2 PROVIDED IN THE SCHEDULE H INSTRUCTIONS (FORM 990) TO CALCULATE A COST OF CHARGE RATIO. THIS RATIO WAS USED TO CALCULATE CHARITY CARE AT COST (A. ABOVE). TO CALCULATE THE UNPAID COSTS OF MEDICAID (B), THE HOSPITAL'S COST ACCOUNTING SYSTEM WAS USED. REMAINING ITEMS WERE REPORTED AT NET EXPENSE PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $3,476,034 PART III, LINE 2: BAD DEBT EXPENSE IS RECORDED AFTER ANY DISCOUNTS AND PAYMENTS ARE MADE ON PATIENT ACCOUNTS.KDOH USED WORKSHEET 2 PROVIDED IN THE SCHEDULE H INSTRUCTIONS (FORM 990) TO CALCULATE A COST OF CHARGE RATIO. THIS RATIO WAS USED TO CALCULATE BAD DEBT EXPENSE AT COST. PART III, LINE 3: THE PATIENT ACCOUNTING TEAM QUERIED THE EPIC SYSTEM TO PULL ANY BAD DEBT ACCOUNT THAT WAS FLAGGED AS HAVING AN INCOMPLETE FA APPLICATION. THE BAD DEBT BALANCE WAS THEN NETTED DOWN TO COST, USING THE COST TO CHARGE RATIO. THE SERVICE WAS STILL PROVIDED, REGARDLESS OF PAYMENT AND THEREFORE THIS SHOULD BE COUNTED AS A PART OF COMMUNITY BENEFIT. PART III, LINE 4: SEE PAGE 11 OF THE AUDITED FINANCIAL STATEMENTS FOR FOOTNOTE. PART III, LINE 8: THE HOSPITAL CONTINUES TO PROVIDE CARE TO ALL PRESENTING AND ADMITTED PATIENTS, REGARDLESS OF ABILITY TO PAY. NOTWITHSTANDING THE COSTS TO PROVIDE CARE, RECEIVING "LESS" THAN WHAT IT COSTS TO PROVIDE ADEQUATE CARE TO MEDICARE COVERED LIVES DOES THE HOPSITAL A DISSERVICE. THIS SHORTFALL SHOULD COUNT AS A COMMUNITY BENEFIT. THE HOSPITAL USES ALLOWABLE COSTS PER THE MEDICARE COST REPORT. PART III, LINE 9B: THE HOSPITAL HAS A WRITTEN POLICY FOR BAD DEBT. UNINSURED PATIENTS ARE SCREENED FOR ELIGIBILITY FOR MEDICARE, MEDICAID AND OTHER SUCH PROGRAMS BY A CONTRACTED VENDOR. ALL PATIENTS, INSURED AND UNINSURED, WITH VALID MAILING ADDRESSES RECEIVE POST-DISCHARGE BILLING STATEMENTS OVER THE COURSE OF A 120 DAY PERIOD. IF THERE ARE NO ACTIVE DISPUTES OR OTHER PAYMENT SOURCES AVAILABLE, AND THE BALANCE IS UNPAID AT THE END OF THE STATEMENT PERIOD, THE ACCOUNT WILL BE PLACED WITH A COLLECTION AGENCY TO REPORT AS A BAD DEBT. EACH STATEMENT INCLUDES INFORMATION REGARDING THE AVAILABILITY OF THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM ALONG WITH A NUMBER WHERE REPRESENTATIVES CAN BE REACHED FOR ASSISTANCE. PART VI, LINE 2: IN ADDITION TO THE TRIANNUAL CHNA, KDOH CONTINUOUSLY MONITORS HOSPITAL DATA AND COMMUNITY SPREAD DISEASES LIKE SEASONAL FLU AND COVID-19. DEPENDING ON THE ISSUE, KDOH RESPONDS WITH STRATEGIES TO HELP MITIGATE THE ISSUE. PART VI, LINE 3: THE MEDICAL CENTER'S FINANCIAL ASSISTANCE POLICY PROVIDES DIRECTION FOR FREE OR DISCOUNTED SERVICES TO RESIDENTS OF THE COMMUNITY WHO HAVE INADEQUATE FINANCIAL RESOURCES TO PAY FOR NECESSARY HEALTHCARE SERVICES PROVIDED BY KING'S DAUGHTERS. THE POLICY STATES THAT THE MEDICAL CENTER WILL NOT DENY CARE TO ANY PATIENT REQUIRING CARE DUE TO THEIR INABILITY TO PAY. THE FINANCIAL ASSISTANCE POLICY PROVIDES GUIDANCE TO PROVIDING ASSISTANCE BASED ON SLIDING SCALE METHODOLOGY AND THE FEDERAL POVERTY GUIDELINES ESTABLISHED BY THE DEPARTMENT OF HEALTH AND HUMAN SERVICES. PATIENTS REQUIRING CARE WITH INCOME BELOW 300% OF THE FEDERAL POVERTYLEVEL QUALIFY FOR FREE OR REDUCED COST SERVICES. KING'S DAUGHTERS ALSO CONTRACTS WITH OUTSIDE VENDORS TO ASSIST PATIENTS IN GOVERNMENT ENROLLMENT PROGRAMS. THERE ARE SIGNS POSTED IN VARIOUS REGISTRATION AREAS INFORMING PATIENTS OF THE PHONE NUMBER TO CALL IF THEY NEED FINANCIAL ASSISTANCE. ON EACH PATIENT STATEMENT THE INFORMATION IS ALSO PRINTED WITH THE PHONE NUMBER. ALL SELF-PAY PATIENTS RECEIVE CORRESPONDENCE AND PHONES CALLS AND INPATIENTS RECEIVE VISITS FROM OUR MEDICAID ELIGIBILITY VENDOR IN REFERENCE TO GOVERNMENT PROGRAMS. PART VI, LINE 4: SCIOTO COUNTY COVERS MORE THAN 610 SQUARE MILES, WITH A POPULATION DENSITY OF 130.3 PEOPLE PER SQUARE MILE. THE POPULATION IS NEARLY EVENLY DIVIDED BETWEEN URBAN AND RURAL, WITH 54.28% RURAL AND 45.72% URBAN. THE LARGEST CITY IN SCIOTO COUNTY IS PORTSMOUTH WITH A POPULATION OF 18,252 (US CENSUS 2019-2023) 5 YEAR ESTIMATES. OTHER NOTABLE CITIES IN SCIOTO COUNTY ARE WHEELERSBURG, LUCASVILLE, AND NEW BOSTON. ACCORDING TO THE US CENSUS BUREAU AMERICAN COMMUNITY SURVEY, SCIOTO COUNTY HAS 73,118 RESIDENTS. OF THE RESIDENTS, 91.6% ARE WHITE, 2.4% ARE NON-HISPANIC BLACK, 1.5% ARE HISPANIC OR LATINO; AND 3.5% NON-HISPANIC MULTIPLE RACES AND 1% NON HISPANIC SOME OTHER RACE. FORTYNINE POINT SIX PERCENT OF THE POPULATION IS MALE AND 50.4% FEMALE. AMONG HOUSEHOLDS IN SCIOTO COUNTY, 1.3% SPEAK A LANGUAGE OTHER THAN ENGLISH. EIGHTY-TWO PERCENT OF HOUSEHOLDS HAVE A COMPUTER, WITH 73.9% HAVING A BROADBAND SERVICE. OF RESIDENTS AGED 25 AND OLDER, 11.3% HAVE NO HIGH SCHOOL DIPLOMA, COMPARED TO 8.4% IN OHIO AND 10.6% NATIONALLY. ONLY 18.0% OF SCIOTO COUNTY RESIDENTS HAVE A BACHELOR'S DEGREE OR HIGHER COMPARED TO OHIO (31.0%) AND THE UNITED STATES (35.0%). THE POPULATION OF SCIOTO COUNTY IS MADE UP OF 5.8% CHILDREN UNDER FIVE; 21.7% CHILDREN/YOUTH UNDER AGE 17; AGE OF 18-24 8.6%; AGE 25-34 12.8%; AGE 35-44 12.1%; AGE 45-54 12.8%; AGE 55-64 13.4%; OVER THE AGE OF 65 IS 18.5% THESE STATISTICS ARE IN LINE WITH OHIO AND UNITED STATES. WITH 22% OF THE POPULATION REPORTS HAVING SOME TYPE OF DISABILITY WHICH IS SIGNIFICANTLY HIGHT THAN OHIO (14.2%) AND THE UNITED STATES (13.0%). MORE THAN 18% OF THE POPULATION UNDER AGE 65 REPORTS HAVING SOME TYPE OF DISABILITY WHICH IS SIGNIFICANTLY HIGHER THAN OHIO (10%) AND THE UNITED STATES (8.6%). SCIOTO COUNTY'S POVERTY RATE OF 23.37% IS HIGHER THAN OHIO (13.24%) AND THE NATION (12.44%). THE MEDIAN INCOME FOR THE COUNTY IS $81,789, WHICH IS WELL BELOW THE STATE ($115,826) AND NATION ($130,215). PER-CAPITA INCOME IN THE COUNTY IS $23,719, COMPARED TO $31,552 FOR OHIO AND $34,103 FOR THE UNITED STATES. THE US CENSUS BUREAU 2020 AMERICAN COMMUNITY SURVEY 2019-2023 5 YEAR ESTIMATES DATA SHOWS THAT AMONG THOSE UNDER AGE 65, 8.4% HAVE NO HEALTH INSURANCE, COMPARED TO 8.4% IN OHIO AND 11.2% NATIONWIDE PART VI, LINE 5: KDOH PROVIDES FREE EDUCATIONAL AND SCREENING SERVICES IN SCIOTO COUNTY, THE PRIMARY MARKET. KDOH WORKS WITH LOCAL HEALTH DEPARTMENTS, CHURCHES, SCHOOLS, BUSINESSES, AND COMMUNITY GROUPS TO HELP IMPROVE HEALTH THROUGHOUT THE COUNTY. THE FOLLOWING ACTIVITIES, WHICH CONTRIBUTE TO COMMUNITY HEALTH WERE PROVIDED:SCREENING AND HEALTH EDUCATION ACTIVITIES:SCREENINGS, IMMUNIZATIONS AND PHYSICALS: FLU SHOTS 50 PROVIDED HEALTHY HEART SCREENING 86 SERVED MOBILE MAMMOGRAPHY 412 SERVED SPORTS PHYSICALS- 309 SERVEDHEALTH EDUCATION: 988 SUICIDE HELP LINE- 1,031 CHF - 295 ADULTS SERVED BREAST CANCER 79 SERVED COLON CANCER 248 SERVED DIABETES - 334 SERVED HEART SIGNS AND SYMPTOMS 282 SERVED HAND WASHING EDUCATION 473 SERVED HEART DISEASE EDUCATION - 390 SERVED HYDRATION - 643 SERVED HYPERTENSION 339 ADULTS SERVED HANDS ONLY CPR- 270 SERVED MENTAL HEALTH - 189 SERVED LUNG CANCER 239 ADULTS SERVED NUTRITION 1,041 SERVED PHYSICAL ACTIVITY- 114 SERVED SAFETY AND GENERAL HEALTH - 200 SERVED POISION-200 SERVED STROKE EDUCATION 326 SERVED SKIN CANCER 67 SERVED TOBACCO, SMOKELESS TOBACCO/VAPING 883 SERVED SUBSTANCE USE DISORDER 282 SERVED SUMMER SAFETY 235 SERVEDTICK BITE EDUCATION- 260 SERVEDBLOOD DRIVES- KDOH COLLABORATED WITH THE RED CROSS TO INCREASE BLOOD DONATIONS BY ENCOURAGING TEAM MEMBERS TO PARTICIPATE IN LOCAL BLOOD DRIVES DURING WORK HOURS. 112 DONATIONS WERE PROVIDED.BACKPACK PROGRAM-TEAM MEMBERS DONATED OVER 220 ITEMS OF SCHOOL AND DISINFECTING SUPPLIES TO PORTSMOUTH ELEMENTARY SCHOOL CHILDREN TO ENSURE STUDENTS START THE YEAR WITH THE NECESSARY SCHOOL SUPPLIES.SALVATION ARMY- KDOH TEAM MEMBERS DONATED TIME, GIFTS AND FOOD TO THE SALVATION ARMY CHRISTMAS EVENT. PART VI, LINE 6: KING'S DAUGHTERS MEDICAL CENTER OHIO IS PART OF AN AFFILIATED HEALTH CARE DELIVERY SYSTEM. THE SYSTEM OPERATES ANOTHER HOSPITAL, KING'S DAUGHTERS MEDICAL CENTER (KDMC) IN ASHLAND, KY. KDOH HAS BEEN SPECIFICALLY DESIGNED TO MEETING THE HEALTHCARE NEEDS OF PORTSMOUTH AND ITS SURROUNDING AREAS. KDOH OFFERS SURGICAL AND URGENT CARE SERVICES. KDOH PROVIDES CHARITY CARE AND PARTICIPATES IN GOVERNMENT PROGRAMS. THE SYSTEM PROVIDES PHYSICIAN SERVICES THROUGH KING'S DAUGHTERS MEDICAL SPECIALTIES, INC. ("KDMS"). KDMS PROVIDES CHARITY CARE AND PARTICIPATES IN GOVERNMENT PROGRAMS. KING'S DAUGHTERS ALSO INCLUDES TWO OTHER AFFILIATES - KING'S DAUGHTERS MEDICAL TRANSPORT, WHICH SEEKS TO CONTINUOUSLY IMPROVE THE PRE- AND POST-HOSPITAL HEALTHCARE PROVIDED IN ALL OF ITS SERVICES AREAS WHILE ENSURING THAT EMERGENCY AND NON-EMERGENCY AMBULANCE SERVICE WILL BE AVAILABLE TO ALL THOSE IN NEED; AND KINGSBROOK NURSING HOME, WHICH PROVIDES QUALITY CARE TO PATIENTS, MEETING THE NEEDS AND DESIRES OF RESIDENTS AT VARIOUS LEVELS OF CARE, INCLUDING SHORT-TERM AND LONG-TERM CARE 1 MARKET SQUARE PARK LLC 1915 SCIOTO TRAIL PORTSMOUTH OH 45662 862608861 501C3 10000 0 SUPPORT OF CONSTRUCTION OF A COMMUNITY PARK IN AN UNDERPRIVILIGED AREA TO HOST COMMUNITY EVENTS AND PROMOTE PHYSICAL ACTIVITY. 2 1 PART I, LINE 2: GRANTS/CONTRIBUTIONS ARE MADE TO ORGANIZATIONS BASED ON THE DATA FROM THE COMMUNITY HEALTH NEEDS ASSESSMENT, NEED OF THE ORGANIZATION, AND THE TYPE OF EVENT IT SUPPORTS. MOST CONTRIBUTIONS ARE TO NON-PROFIT ORGANIZATIONS THAT FULFULL A NEED IN THE COMMUNITY, PROMOTE HEALTH LIVING AND/OR ARE ECONOMIC-DEVELOPMENT BASED. ALL REQUEST MUST BE MADE IN WRITING TO OUTLINING WHAT IS NEEDED AND HOW IT WILL BE USED. CONTRIBUTIONS ARE TRACKED AND DOCUMENTED. 1 0 1 0 0 0 0 0 1 0 SARA MARKS PRESIDENT/CEO 0 602112 0 316250 0 139541 0 115525 0 22681 0 1196109 0 100000 AUTUMN MCFANN TREASURER 0 619374 0 265400 0 132947 0 115525 0 22237 0 1155483 0 100000 TONY VIRGIN PHYSICIAN 155081 583434 0 0 0 11304 0 19275 0 25417 155081 639430 0 0 CHARLES L CONLEY PHYSICIAN 162463 520089 0 0 0 1869 0 10350 0 38512 162463 570820 0 0 AMY SAUNDERS ASSISTANT SECRETARY 0 237373 0 23706 0 1129 0 11858 0 15608 0 289674 0 0 CRAIG HAZELBAKER PHARMACIST / PHARMACY SUPERVISOR 167277 0 8320 0 1235 0 7976 0 21323 0 206131 0 0 0 ROY ADAMS PHC MEDICAL DIRECTOR, PHYSICIAN 1188 162717 0 0 0 848 7372 0 23292 0 31852 163565 0 0 MELISSA WATSON PHARMACIST 164288 23 2455 0 193 0 7554 0 20873 0 195363 23 0 0 CANDICE TACKETT EXECUTIVE DIRECTOR (UNTIL 10/25) 148509 0 14922 0 285 0 4044 0 21296 0 189056 0 0 0 JAMES NEAL CNO/ADMINISTRATOR 137174 0 13714 0 593 0 6813 0 11785 0 170079 0 0 0 PART I, LINE 3 COMPENSATION FOR THE CEO IS DETERMINED BY ASHLAND HOSPITAL CORPORATION (RELATED ORGANIZATION) USING THE FOLLOWING METHODS: INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY/STUDY, AND APPROVAL BY THE BOARD. PART I, LINE 4B THE FOLLOWING INDIVIDUALS RECEIVED PAYMENTS FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: - AUTUMN MCFANN: $31,237 - SARA MARKS $36,931 THE CEO AND CERTAIN VICE PRESIDENTS, WHOSE BENEFIT IN THE QUALIFIED TAX SHELTERED ANNUITY PLAN IS LIMITED DUE TO THE IRS COMPENSATION AND BENEFIT LIMITS, RECEIVE A BENEFIT RESTORATION CONTRIBUTION UNDER THE DEFERRED ANNUITY PLAN THAT IS PAID AS A TAXABLE DISTRIBUTION TO THE PARTICIPANT ANNUALLY. PART I, LINE 7 NONFIXED PAYMENTS ARE MADE AS A PART OF THE MEDICAL CENTER'S TEAM INCENTIVE AWARD (TIA) PLAN. ALL TEAM MEMBERS ARE ELIGIBLE FOR THE TIA. THE TIA IS PAID OUT BASED UPON SUCCESSFUL COMPLETION OF BOTH QUANTITATIVE AND QUALITATIVE STRATEGIC GOALS, SET ANNUALLY BY THE MEDICAL CENTER LEADERSHIP TEAM AND APPROVED BY THE BOARD OF DIRECTORS. FORM 990, PART V, LINE 1A: THERE IS NO SEPARATE FORM 1096 FILED BY PORTSMOUTH HOSPITAL CORPORATION. ALL THE PAYMENTS ARE MADE BY ASHLAND HOSPITAL CORPORATION AN AFFILIATE ENTITY, UNDER ITS EIN 61-0444716. FORM 990, PART VI, SECTION A, LINE 6 ROYAL BLUE HEALTH, LLC (RBH) IS THE SOLE CORPORATE MEMBER OF PORTSMOUTH HOSPITAL CORPORATION (PHC). FORM 990, PART VI, SECTION A, LINE 7A THE PHC BOARD IS FOLDED INTO THE MAIN BOARD OF TRUSTEES OF THE HEALTH SYSTEM. THE BUSINESS OF PHC IS INCORPORATED INTO THE BUSINESS OF THE FULL BOARD INDEPENDENTLY, OR THROUGH ITS COMMITTEES. FORM 990, PART VI, SECTION A, LINE 7B AS THE PARENT ORGANIZATION OF THE HEALTH CARE SYSTEM, AS WELL AS THE SOLE MEMBER OF PHC, RBH HAS ALL GOVERNING AUTHORITY. ANY LOCAL BOARD OF DIRECTORS IS ADVISORY ONLY. AT THIS TIME THERE IS NOT AN ADVISORY BOARD FOR PHC. FORM 990, PART VI, SECTION B, LINE 11B THE 990 WILL BE REVIEWED BY THE CEO AND CONTROLLER BEFORE IT IS FILED WITH THE IRS. THE 990 WILL BE KEPT ON FILE AND AVAILABLE FOR REVIEW BY BOARD MEMBERS UPON REQUEST. FORM 990, PART VI, SECTION B, LINE 12C PORTSMOUTH HOSPITAL CORPORATION DBA KING'S DAUGHTERS MEDICAL CENTER OHIO (KDOH), THROUGH ITS SOLE MEMBER, REQUIRES ALL DIRECTORS AND OFFICERS TO COMPLY WITH ITS CONFLICTS OF INTEREST POLICY, WHICH TRACKS THE IRS'S RECOMMENDED POLICY WITH RESPECT TO SUCH OFFICERS AND DIRECTORS. MEMBERS OF THE KDOH'S BOARD OF DIRECTORS MUST ANNUALLY IDENTIFY, IN WRITING, ANY INTEREST THAT COULD GIVE RISE TO A CONFLICT, SUCH AS A LEADERSHIP POSITION IN A CONFLICTING ORGANIZATION; DISCLOSURE IS NOT LIMITED TO FINANCIAL CONFLICTS. IN ADDITION, EMPLOYEES OF KDOH CERTIFY THAT NO CONFLICTS OF INTEREST EXIST OR OBTAIN AN ADVANCE WAIVER OF ANY CONFLICTS. KDOH'S GENERAL COUNSEL OBTAINS ALL RELEVANT DISCLOSURES AND SIGNATURES. IF A CONFLICT OF INTEREST IS REPORTED, THE VICE PRESIDENT TO WHOM THE REPORTING EMPLOYEE DIRECTLY OR INDIRECTLY REPORTS, TOGETHER WITH THE CEO, DETERMINES IF A CONFLICT EXISTS. IF THE REPORTING EMPLOYEE IS A VICE PRESIDENT, THE CEO, IN CONSULTATION WITH THE GENERAL COUNSEL, DETERMINES IF A CONFLICT EXISTS. BOARD MEMBERS COMPLETE ANNUAL ATTESTATIONS IDENTIFYING POTENTIAL CONFLICTS OF INTEREST. IF A CONFLICT EXISTS, IT IS REPORTED TO THE CHAIRMAN OF THE BOARD, THE CEO, AND/OR GENERAL COUNSEL AS APPROPRIATE. IF IT IS DETERMINED THAT A CONFLICT EXISTS, THE EMPLOYEE OR BOARD MEMBER IS REMOVED FROM ANY PART OF THE DECISION-MAKING PROCESS, AND HAS NO ROLE IN THE INSTANCE IN WHICH THE CONFLICT EXISTS. A BOARD MEMBER WHO REPORTS A POTENTIAL OR ACTUAL CONFLICT OF INTEREST MUST ABSTAIN FROM ANY RELEVANT DISCUSSION OR VOTE. IF A CONFLICT OF INTEREST IS DISCOVERED AFTER THE FACT, THE CEO AND VICE PRESIDENT, TOGETHER WITH THE GENERAL COUNSEL, IF APPROPRIATE, REVIEWS THE INSTANCE IN WHICH THE CONFLICT OCCURRED. THOSE LEADERS ENSURE THAT THE CONFLICTED INDIVIDUAL DID NOT INFLUENCE DECISION MAKING OR PROFIT FROM THE CONFLICT. THE CONFLICTED INDIVIDUAL IS REMOVED FROM ANY FURTHER INVOLVEMENT. IN ADDITION, ANY FAILURE TO REPORT CONFLICTS OF INTEREST VIOLATES THE POLICY AND COULD RESULT IN DISCIPLINARY ACTION, UP TO AND INCLUDING TERMINATION OF EMPLOYMENT OR REMOVAL FROM THE MEDICAL CENTER'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 AT THE DIRECTION OF THE BOARD OF DIRECTORS, KDMC SET COMPENSATION FOR THE TEAM MEMBERS AND LEADERS USING LOCAL, REGIONAL AND NATIONAL SALARY INFORMATION PROVIDED THROUGH SURVEY DATA. THE PRIMARY OBJECTIVE OF KING'S DAUGHTERS COMPENSATION PHILOSOPHY IS TO HAVE COMPENSATION AND BENEFITS SET THAT REFLECT OTHER SIMILAR INDEPENDENT NOT FOR PROFIT HEALTHCARE SERVICES AS WELL AS THE WORK PERFORMANCE OF THE ORGANIZATION. MERCER, AN INDEPENDENT COMPENSATION EXPERT, PERIODICALLY PERFORMS A REVIEW OF EXECUTIVE COMPENSATION AND BENEFITS. SULLIVAN COTTER, AN INDEPENDENT COMPENSATION EXPERT, PROVIDES ANNUAL MARKET SURVEY DATA FOR PHYSICIAN COMPENSATION AND BENEFITS WHICH IS USED FOR DETERMINATION OF FAIR MARKET VALUE. FORM 990, PART VI, SECTION C, LINE 19 ON A QUARTERLY BASIS, THE FINANCIAL STATEMENTS ARE REPORTED TO EMMA (ELECTRONIC MUNICIPAL MARKET ACCESS) AND MADE AVAILABLE ON THEIR WEBSITE. GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: FORGIVENESS OF INTERCOMPANY RECEIVABLE -7,039,222. ASHLAND NURSING HOME CORPORATION 2500 STATE ROUTE 5 ASHLAND KY 41102 611386016 NURSING HOME KY 501(C)(3) LINE 10 ASHLAND HOSPITAL COPORATION 0 CHILD DEVELOPMENT CENTER CORPORATION 2201 LEXINGTON AVENUE ASHLAND KY 41101 010560598 CHILD CARE KY 501(C)(3) LINE 10 ASHLAND HOSPITAL COPORATION 0 KENTUCKY HEART INSTITUTE INC 2201 LEXINGTON AVENUE ASHLAND KY 41101 611255904 PHYSICIANS KY 501(C)(3) LINE 10 ASHLAND HOSPITAL COPORATION 0 KENTUCKY HEART FOUNDATION INC 2201 LEXINGTON AVENUE ASHLAND KY 41101 260791997 MEDICAL RESEARCH KY 501(C)(3) LINE 7 ASHLAND HOSPITAL COPORATION 0 KENTUCKY MEDICAL LOGISTICS INC 201 SOUTHLAND DRIVE ASHLAND KY 41102 264736971 MEDICAL TRANSPORT KY 501(C)(3) LINE 10 ASHLAND HOSPITAL COPORATION 0 KING'S DAUGHTERS MEDICAL SPECIALTIES INC 2201 LEXINGTON AVENUE ASHLAND KY 41101 264183569 PHYSICIANS KY 501(C)(3) LINE 10 ASHLAND HOSPITAL COPORATION 0 ASHLAND HOSPITAL CORPORATION 2201 LEXINGTON AVENUE ASHLAND KY 41101 610444716 HEALTHCARE KY 501(C)(3) LINE 3 ROYAL BLUE HEALTH LLC 0 ROYAL BLUE HEALTH LLC 2201 LEXINGTON AVENUE ASHLAND KY 41101 862993817 HEALTHCARE KY 501(C)(3) LINE 12B, II N/A 0 KING'S DAUGHTERS HEALTH SYSTEM 2201 LEXINGTON AVENUE ASHLAND KY 41101 274553836 HEALTHCARE KY 501(C)(3) LINE 12B, II N/A 0 ASHLAND MEDICAL PROPERTIES INC 2201 LEXINGTON AVE ASHLAND KY 41101 611079090 RENTALS KY N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1