2023-11-10T09:11:58-06:00 2022-12-31 FORVIS LLP PO BOX 1196 BOWLING GREEN KY 42102 990 2022-01-01 610482973 JENNIE STUART MEDICAL CENTER INC % MARK LARAMEE JENN 2708870100 320 W 18TH STREET HOPKINSVILLE KY 42240 MARK LARAMEE CFO 2708870239 2023-10-15 true MARK LARAMEE 999009999 P00289876 2707810111 2 2022 2023-04-26 12:10:37Z ERIC LEE 320 W 18TH STREET HOPKINSVILLE KY 42240 193428631 false X WWW.JENNIESTUARTHEALTH.ORG X 1914 KY JSMC IS COMMITTED TO EXCELLENCE IN SERVICE, AND WE EXIST TO PROMOTE, PRESERVE AND ACCOMMODATE THE GROWING HEALTHCARE NEEDS OF OUR COMMUNITY. 12 10 1161 10 0 0 87102 5634853 174377273 165277771 3988437 3150950 718131 1236033 179170943 175299607 158077 158788 0 0 69973583 84799252 0 0 0 86040117 90110239 156171777 175068279 22999166 231328 272583736 257029546 123065363 121359863 149518373 135669683 JSMC IS COMMITTED TO EXCELLENCE IN SERVICE, AND WE EXIST TO PROMOTE, PRESERVE AND ACCOMMODATE THE GROWING HEALTHCARE NEEDS OF OUR COMMUNITY. false false 149678193 165277771 PROVIDE HOSPITAL INPATIENT, OUTPATIENT, AND EMERGENCY ROOM SERVICES TO AREA RESIDENTS. IN RECOGNITION OF ITS MISSION, JSMC WILL STRIVE TO PASSIONATELY PURSUE A CULTURE OF EXCEPTIONAL SERVICE AND A COMMITMENT TO CONTINUOUS QUALITY IMPROVEMENT. THE AMOUNT OF CHARITY CARE AT COST WAS APPROXIMATELY $198,000 FOR THE YEAR ENDED DECEMBER 31, 2022. 149678193 true true false true false false false false false true true false false true true false true false false false false false false false false false true true true false true true false false false false false false false false false false false false false false true true true true false false true 78 0 true 1161 true false false false false false false false false false false false false X 12 10 false true false false false false false true true false false true true true true true true true true true true KY X MARK LARAMEE 2708870251 320 W 18TH STREET HOPKINSVILLE KY 42240 FREDERICK ROBBE III PHYSICIAN 40.0 0.0 X 959812 0 9100 TANNER PARRENT PHYSICIAN 40.0 0.0 X 928653 0 16530 JOSHUA HORTON PHYSICIAN 40.0 0.0 X 868518 0 9948 DAVID BEALLE PHYSICIAN 40.0 0.0 X 842149 0 17751 GERAME WELLS PHYSICIAN 40.0 0.0 X 720693 0 17751 KEITH TOMS VP OF INTEGRATED SERVICES 40.0 0.0 X 208953 0 11332 BETH MCCRAW CHIEF NURSING OFFICER 40.0 0.0 X 203472 0 11912 JASMINE EMERSON AVP OF HUMAN RESOURCES 40.0 0.0 X 117833 0 10893 ALISSA YOUNG BOARD MEMBER 1.0 0.0 X 0 0 0 BETSY SHELTON BOARD MEMBER 1.0 0.0 X 0 0 0 CARTER HENDRICKS BOARD MEMBER 1.0 0.0 X 0 0 0 CHARLES TURNER MEMBER AT LARGE 1.0 0.0 X X 0 0 0 DERRICK WATSON BOARD CHAIR 1.0 0.0 X X 0 0 0 HOLLIS WHITE BOARD MEMBER 1.0 0.0 X 0 0 0 JANET CALHOUN SECRETARY / TREASURER 1.0 0.0 X X 0 0 0 LESLIE CARROLL BOARD VICE CHAIRMAN 1.0 0.0 X X 0 0 0 MARTY BOZARTH BOARD MEMBER 1.0 0.0 X 0 0 0 CASEY COVINGTON MD PRESIDENT ELECT MEDICAL STAFF 1.0 0.0 X X 0 0 0 STEVE TRIBBLE BOARD MEMBER 1.0 0.0 X 0 0 0 MICHAEL CLARK MD MED STAFF PRESIDENT 1.0 0.0 X X 0 0 0 ERIC LEE CEO 40.0 0.0 X 0 0 0 MARK LARAMEE CFO 40.0 0.0 X 0 0 0 4850083 0 105217 69 false true true THERAPY STAFFING SPECIALISTS 755 EVERETT LANE HOPKINSVILLE KY 42240 STAFFING SERVICES 3056073 HUDSON STAFFING PLLC 4409 IVAN CREEK DR FRANKLIN TN 37064 STAFFING SERVICES 2769492 MEDICAL STAFFING SOLUTIONS 9700 HWY 57 NORTH SUITE A EVANSVILLE IN 47725 STAFFING SERVICES 957268 QHR HEALTH LLC DBA OVATION HEALTH 105 CONTINENTAL PLACE BRENTWOOD TN 37027 MANAGEMENT SERVICES 1493563 AMN WORKFORCE SOLUTIONS LLC 8840 CYPRESS WATERS BLVD STE 300 DALLAS TX 75019 STAFFING 976750 18 5584853 50000 5634853 NET PATIENT REVENUE 621110 165253201 165253201 BIO MED INCOME 621110 24570 24570 165277771 2670944 2670944 0 0 493595 208093 285502 0 285502 285502 18400937 17920931 480006 480006 480006 0 0 0 0 0 0 0 0 0 CAFETERIA SALES 722514 325135 325135 MISC REVENUE 900099 625396 625396 950531 175299607 165277771 4386983 158788 158788 0 0 0 530257 530257 0 72308752 64580057 7728695 761717 684875 76842 6709899 5597225 1112674 4488627 4016158 472469 1308245 1308245 209144 44213 164931 195440 195440 5611 5611 0 0 22635760 18650732 3985028 298140 257 297883 3356134 1810385 1545749 3812392 2950786 861606 0 3305231 3214811 90420 191127 163846 27281 0 48698 48698 3812624 3568693 243931 0 7837655 6263046 1574609 1655137 243756 1411381 MEDICAL SUPPLIES 32890933 32869873 21060 DUES & SUBSCRIPTIONS 549963 199499 350464 PROVIDER TAX 3616576 3616576 REPAIRS & MAINTENANCE 1196185 922213 273972 3185244 73706 3111538 175068279 149678193 25390086 0 29057284 10036920 125752069 128286611 0 0 20091732 17549925 0 0 0 0 0 0 2382658 2793297 2619724 2296550 195542980 122329535 67250611 73213445 0 0 0 0 1384897 1125441 0 0 24044761 21727357 272583736 257029546 17151230 21933381 0 0 0 0 58859840 62234732 0 0 0 0 5207964 7013683 0 0 41846329 30178067 123065363 121359863 X 146838391 132445268 2679982 3224415 149518373 135669683 272583736 257029546 X 231328 -13868457 -211561 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 5611 5611 false SCHEDULE C, PART 11-B, LINE 1I LOBBYING EXPENSE ----------------- JENNIE STUART PAYS DUES TO THE KENTUCKY HOSPITAL ASSOCIATION. A PORTION OF THESE DUES ARE FOR LOBBYING. 1592509 -190897 9414 1392198 1422853 205136 35480 1592509 1304660 155745 37552 1422853 1181161 197048 73549 1304660 1245729 -64568 1181161 1.00000 false false 9150634 9150634 108050867 66427088 41623779 239365 119532 119833 70177036 54597517 15579519 7925078 1185398 6739680 73213445 ROU ASSETS 18287287 INSURANCE RECOVERIES 2729678 OTHER ASSETS 710392 21727357 0 THIRD PARTY SETTLEMENTS 2385706 MEDICAL MALPRACTICE LIABILITY 8508401 LEASE LIABILITIES 19283960 MEDICARE ADVANCE PAYMENTS 0 30178067 162403587 -13868457 923132 -12945325 175348912 -49305 -49305 175299607 175567540 658049 658049 174909491 158788 158788 175068279 SCHEDULE D, PART V, LINE 4 ENDOWMENT FUNDS ---------------- INVESTMENTS TO BE HELD IN PERPETUITY, THE INCOME OF WHICH IS RESTRICTED FOR OPERATIONS OF THE MEDICAL CENTER. SCHEDULE D, PART X, LINE 2 UNCERTAIN TAX POSITIONS ----------------------- THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS DID NOT INCLUDE A FOOTNOTE THAT ADDRESSED THE ORGANIZATION'S LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER FIN48 (ASC 740). MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. SCHEDULE D, PART XI LINE 2D ---------- REVENUE REPORTED ON JENNIE STUART HEALTH FOUNDATION 990 923,132 LINE 4B --------- AUDIT ELIMINATION FOR CONTRIBUTION TO FOUNDATION 158,788 RENTAL EXPENSE NETTED AGAINST REVENUE PER TAX RETURN (208,093) ------------ ( 49,305) SCHEDULE D, PART XII LINE 2D --------- EXPENSES REPORTED ON JENNIE STUART FOUNDATION 990 238,396 RENTAL EXPENSE NETTED AGAINST REVENUE PER TAX RETURN 208,093 DISTRIBUTION TO NON-CONTROLLING INTEREST 211,560 ------------ 658,049 LINE 4B ---------- AUDIT ELIMINATION FOR CONTRIBUTION TO FOUNDATION 158,788 true true X true X 400. true X true true false true true 2082862 11185695 0.00000 29498096 40067897 31580958 51253592 0.00000 31580958 51324012 0.00000 18009 18009 97956 97956 115965 115965 true 12269000 6134500 26401120 33227082 -6825962 X true true PHYSICIANS HOLDINGS RENTAL ACTIVITY 0.57 0.43 1 1 JENNIE STUART MEDICAL CENTER 320 WEST 18TH STREET HOPKINSVILLE KY 42240 WWW.JENNIESTUARTHEALTH.ORG 100068 X X X JENNIE STUART MEDICAL CENTER 1 false false true X X X X X X X X X 22 true false false true X SEE SCHEDULE H, PART V, SECTION C X true 22 true SEE SCHEDULE H, PART V, SECTION C false true X 139. 400. X X X X X true true X X X true X SEE SCHEDULE H, PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 CHNA COMMUNITY INPUT --------------------- INPUT FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT WAS ASKED FROM INDIVIDUALS WITH KNOWLEDGE OF THE COMMUNITY AND EXPERTISE. INPUT WAS PROVIDED THROUGH A COUPLE INTERNET-BASED SURVEYS WITH LOCAL EXPERT ADVISORS WHO REPRESENT THE HOSPITAL'S COMMUNITY AS WELL AS THOSE WHO WORK WITH VULNERABLE POPULATIONS AND WHO HAVE HEALTH KNOWLEDGE. SCHEDULE H, PART V, SECTION B, LINE 7 & 10 CHNA / IMPLEMENTATION STRATEGY ------------------------------- THE FULL CHNA AND IMPLEMENTATION STRATEGY REPORT MAY BE OBTAINED AT: HTTPS://WWW.JENNIESTUARTHEALTH.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSM ENT SCHEDULE H, PART V, SECTION B, LINE 11 NEEDS NOT IDENTIFIED ----------------------- THE HOSPITAL DID NOT ADDRESS EVERY NEED IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT BECAUSE SOME OF THE NEEDS FELL OUT OF THE SCOPE OF EXPERTISE AND RESOURCES OF THE HOSPITAL, WHILE OTHER NEEDS WERE ALREADY BEING ADDRESSED IN THE COMMUNITY. SCHEDULE H, PART V, SECTION B, LINE 16 MEASURES TO PUBLICIZE FINANCIAL ASSISTANCE POLICY ------------------------------------------------- THE ENTIRE FINANCIAL ASSISTANCE POLICY IS AVAILABLE ON THE HOSPITAL'S WEBSITE AND UPON REQUEST. INFORMATION REGARDING HOW TO OBTAIN THE FINANCIAL ASSISTANCE POLICY IS INCLUDED ON BILLING INVOICES AND IN POSTINGS IN THE HOSPITAL WAITING ROOMS. THE FULL FINANCIAL ASSISTANCE POLICY MAY BE OBTAINED AT: HTTPS://WWW.JENNIESTUARTHEALTH.ORG/PATIENT-VISITORS/FINANCIAL-ASSISTANCE-G UIDELINES 18 JENNIE STUART AMBULATORY SURGERY DEPT 8250 EAGLE WAY HOPKINSVILLE KY 42240 OUTPATIENT SURGERY DEPARTMENT JENNIE STUART MEDICAL IMAGING CENTER 110 NICK TERHUNE BLVD HOPKINSVILLE KY 42240 DIAGNOSTIC IMAGING DEPT OF GASTROENTEROLOGY 231 BURLEY AVE HOPKINSVILLE KY 42245 PHYSICIAN OFFICE DEPT OF GENERAL SURGERY 1724 KENTON ST SUITE 2B HOPKINSVILLE KY 42249 PHYSICIAN OFFICE DEPT OF DERMATOLOGY 10755 EAGLE WAY HOPKINSVILLE KY 42243 PHYSICIAN OFFICE DEPT OF FAMILY HEALTH 223 BURLEY AVE HOPKINSVILLE KY 42242 PHYSICIAN OFFICE DEPT OF UROLOGY 219 W 17TH ST HOPKINSVILLE KY 42247 PHYSICIAN OFFICE DEPT OF GENERAL SURGERY 1722 HIGH ST HOPKINSVILLE KY 42248 PHYSICIAN OFFICE WKY ORTHOPEDIC AND SPORTS MEDICINE 10755 EAGLE WAY HOPKINSVILLE KY 42246 PHYSICIAN OFFICE DEPT OF FAMILY HEALTH 120 N MAIN ST TRENTON KY 42286 PHYSICIAN OFFICE DEPT OF FAMILY HEALTH 222 W 18TH ST HOPKINSVILLE KY 42241 PHYSICIAN OFFICE DEPT OF OBSTETRICS AND GYNECOLOGY 1717 HIGH STREET SUITE 4B HOPKINSVILLE KY 42244 PHYSICIAN OFFICE JENNIE STUART EXPRESS LAB 110 NICK TERHUNE BOULEVARD HOPKINSVILLE KY 42240 EXPRESS LAB JENNIE STUART PHYSICAL THERAPY 10755 EAGLE WAY HOPKINSVILLE KY 42240 PHYSICAL THERAPY JENNIE STUART HOME HEALTH 320 WEST 18TH STREET HOPKINSVILLE KY 42240 HOME HEALTH JENNIE CARE 10755 EAGLE WAY HOPKINSVILLE KY 42240 PHYSICIAN OFFICE DEPT OF ENT 10755 EAGLE WAY HOPKINSVILLE KY 42240 PHYSICIAN OFFICE DEPT OF OBSTETRICS AND GYNECOLOGY 1621 NASHVILLE STREET SUITE 102 RUSSELLVILLE KY 42276 PHYSICIAN OFFICE SCHEDULE H, PART III, SECTION A, LINE 2 & 3 BAD DEBT EXPENSE ---------------- THE HOSPITAL HAS ADOPTED THE NEW REVENUE RECOGNITION STANDARD ASU 2014-09. UNDER ASU 2014-09, THE ESTIMATED AMOUNTS DUE FROM PATIENTS FOR WHICH THE HOSPITAL DOES NOT EXPECT TO BE ENTITLED OR COLLECT FROM THE PATIENTS ARE CONSIDERED IMPLICIT PRICE CONCESSIONS AND EXCLUDED FROM THE HOSPITAL'S ESTIMATION OF THE TRANSACTION PRICE OR REVENUE RECORDED. BAD DEBT EXPENSE WAS NOT SIGNIFICANT TO THE AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED DECEMBER 31, 2022. HOWEVER, THE HOSPITAL INTERNALLY TRACKS BAD DEBT EXPENSE CONSISTENT WITH HISTORICAL PRACTICES AND THAT AMOUNT HAS BEEN REPORTED ON SCHEDULE H, PART III, SECTION A, LINE 2. APPROXIMATELY 50% OF ACCOUNTS WRITTEN OFF AS BAD DEBT WOULD QUALIFY FOR CHARITY CARE IF THE NECESSARY DOCUMENTATION WERE RECEIVED BY JENNIE STUART MEDICAL CENTER. SCHEDULE H, PART III, LINE 8 CALCULATION OF MEDICARE ALLOWABLE COSTS ---------------------------------------- COSTS REPORTED ON LINE 6 ARE OBTAINED USING THE MEDICARE COST REPORT COST TO CHARGE RATIO. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT ----------------- DURING THE STRATEGIC BUSINESS PLANNING SESSION, THE ADMINISTRATIVE GROUP ANALYZES NEW SERVICES THAT MAY BE NEEDED. THIS PLAN IS BASED ON 5 PILLARS, ONE OF WHICH IS GROWTH. JSMC RECRUITS AND ENGAGES KEY STAKEHOLDERS AND WORKS TO HELP ASSESS RESULTS IN ADDRESSING COMMUNITY WIDE NEEDS. FEEDBACK FROM SURVEYS AND CITIZENS IN OUR COMMUNITY PROVIDE US WITH INPUT AND FEEDBACK. SEE THE FULL REPORT ON THE HOSPITAL'S WEBSITE AT: HTTP://WWW.JENNIESTUARTHEALTH.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSME NT/ SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE ------------------------------------------------ SIGNS AND MONITORS ARE DISPLAYED IN REGISTRATION AREAS TO NOTIFY PATIENTS REGARDING THE PROGRAMS AVAILABLE. COPIES OF THE FAP AND BILLING AND COLLECTION POLICIES ARE AVAILABLE ON THE HOSPITAL WEBSITE AS WELL AS IN PAPER FORM BY REQUEST. ALSO, COUNSELORS ARE AVAILABLE TO PROVIDE INFORMATION AND WORK WITH PATIENTS. ALL REGISTRARS AND BILLING CLERKS RECEIVE EDUCATION REGARDING POLICIES AND PRACTICES. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION ----------------------- JSMC IS THE ONLY NON-MILITARY ACUTE CARE FACILITY IN CHRISTIAN COUNTY, KENTUCKY. CHRISTIAN, TODD, AND TRIGG COUNTIES MAKE UP JSMC'S PRIMARY SERVICE AREA. JSMC'S SECONDARY SERVICE AREA IS COMPRISED OF CALDWELL, HOPKINS, AND MUHLENBERG COUNTIES IN KENTUCKY. HOPKINSVILLE IS THE 7TH LARGEST CITY IN KY AND IS APPROXIMATELY 75 MILES FROM NASHVILLE, TN. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH ------------------------------ JENNIE STUART IS ONE OF THE MOST WIDELY ENGAGED OPERATING ENTITIES IN OUR REGION, WORKING WITH A MULTITUDE OF KEY COMMUNITY IMPACT ORGANIZATIONS TO MEET THE NEEDS OF THE PEOPLE OF OUR COMMUNITY AND WESTERN KENTUCKY. OUR PRIMARY COLLABORATITIVE ENTITY IN MEETING THE NEEDS OF OUR PATIENTS AND THE COMMUNITY IS THE MEDICAL STAFF OF JENNIE STUART MEDICAL CENTER. JSMC WAS THE SPONSOR OF THE LOCAL AMERICAN CANCER SOCIETY'S RELAY FOR LIFE AND MATCHES FUNDS RAISED FOR LOCAL PINK RIBBON NETWORK. THROUGH A KENTUCKY COLON CANCER GRANT JSMC PROVIDES COLONOSCOPIES TO PATIENTS THAT NEED ASSISTANCE WITH FUNDS. JSMC ALSO PARTNERED WITH PENNYROYAL CENTER TO PROVIDE TELEPSYCHIATRIC SERVICES. JSMC WAS A MAJOR SPONSOR OF AMERICAN HEART ASSOCIATION'S LOCAL HEART WALK AND SPONSORS LOCAL EVENTS THAT PROMOTE PHYSICAL ACTIVITY INCLUDING 5KS, RUN/WALKS AND SENIOR OLYMPICS. JSMC PARTICIPATES IN MULTIPLE COMMUNITY HEALTH FAIRS TO PROVIDE FREE SCREENINGS FOR BLOOD SUGAR, BLOOD PRESSURE, AND BMI. JSMC HOSTED A YEARLY BACK TO SCHOOL CLINIC AND PROVIDES EDUCATION IN SCHOOLS ON ALCHOHOL AND SUBSTANCE ABUSE THROUGH THE HEALTH EDUCATION TEAM. SCHEDULE H, PART I, LINE 7, COL (F) & SCHEDULE H, PART II, COL (F) PERCENT OF TOTAL EXPENSE: ------------------------ TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25, OF THE FORM 990. SCHEDULE H, PART I, LINE 7 COSTING METHODOLOGY ------------------- THE MEDICARE COST TO CHARGE RATIO WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEETS 1 AND 3. true JENNIE STUART HEALTH FOUNDATION PO BOX 608 HOPKINSVILLE KY 42241 822980765 501(C)3 158788 ADMIN SUPPORT 1 SCHEDULE I, PART I, LINE 2 MONITORING THE USE OF GRANT FUNDS ------------------------------------ ADMINISTRATIVE EXPENSES FOR THE JENNIE STUART HEALTH FOUNDATION, A PHILANTHROPIC SUBSIDIARY OF JENNIE STUART HEALTH, ARE PROVIDED BY JENNIE STUART HEALTH TO ALLOW THE FOUNDATION TO DIRECTLY SUPPORT COMMUNITY CARE AND SERVICE EXPANSION. X true true X false false false false false true false false false ERIC LEE CEO 0 0 0 0 0 0 0 0 0 0 0 0 0 0 MARK LARAMEE CFO 0 0 0 0 0 0 0 0 0 0 0 0 0 0 JASMINE EMERSON AVP OF HUMAN RESOURCES 117013 0 820 1959 8934 128726 0 BETH MCCRAW CHIEF NURSING OFFICER 178053 21401 4018 6004 5908 215384 0 KEITH TOMS VP OF INTEGRATED SERVICES 186010 21732 1211 5121 6211 220285 0 DAVID BEALLE PHYSICIAN 600248 238841 3060 9150 8601 859900 0 FREDERICK ROBBE III PHYSICIAN 621988 332892 4932 9100 0 968912 0 GERAME WELLS PHYSICIAN 396161 324240 292 9150 8601 738444 0 TANNER PARRENT PHYSICIAN 448347 480306 0 9150 7380 945183 0 JOSHUA HORTON PHYSICIAN 520506 348012 0 9150 798 878466 0 SCHEDULE J, PART I, LINE 1A BENEFITS PROVIDED ------------------ COUNTRY CLUB MEMBERSHIP DUES WERE PAID FOR THE CEO AND WERE EXCLUDED FROM TAXABLE COMPENSATION. SCHEDULE J, PART II COMPENSATION FROM UNRELATED ORGANIZATIONS ------------------------------------------ THE HOSPITAL CONTRACTS THE SERVICES OF ERIC LEE (CEO) AND MARK LARAMEE (CFO) WITH QHR (FORMERLY QUORUM HEALTH RESOURCES, INC.), AN UNRELATED ORGANIZATION. QHR WAS PAID $778,809 FOR SERVICES PROVIDED BY THESE INDIVIDUALS DURING 2022. SCHEDULE J, PART II COMPENSATION REPORTED --------------------- THE FOLLOWING INDIVIDUALS' COMPENSATION IS PAID FROM JENNIE STUART MEDICAL GROUP, A DISREGARDED ENTITY OF JENNIE STUART MEDICAL CENTER: - DAVID BEALLE - JOSHUA HORTON - FREDERICK ROBBE III - TANNER PARRENT - GERAME WELLS SCHEDULE J, PART I, LINE 6A LEADERSHIP INCENTIVE PLAN -------------------------- JSMC'S ANNUAL INCENTIVE PLAN IS BASED ON THE FOLLOWING GUIDING PRINCIPLES: - SUPPORT THE MISSION OF JSMC - RETAIN AND MOTIVATE A HIGH PERFORMANCE EXECUTIVE TEAM - REWARD SUCCESS IN ACHIEVING MEASURABLE FINANCIAL, QUALITY AND STRATEGIC GOALS - ALIGN INCENTIVE COMPENSATION AWARDS WITH THE STRATEGIC PLAN OF JSMC - ENCOURAGE HIGH LEVELS OF TEAM AND INDIVIDUAL PERFORMANCE PLAN PARTICIPANTS INCLUDE SELECT LEADERS AND MANAGERS AT JSMC. THE ANNUAL INCENTIVE AWARD LEVELS ARE: - THRESHOLD = 5% OF BASE SALARY - TARGET = 10% OF BASE SALARY - MAXIMUM = 15% OF BASE SALARY PERFORMANCE MEASURES ARE BASED ON THE PARTICIPANT'S PROGRESS AGAINST THE FOLLOWING METRICS: 1. PATIENT EXPERIENCE - HCAHPS SCORES MEETING AND/OR EXCEEDING TARGET 2. QUALITY - READMISSION RATES MEETING AND/OR EXCEEDING TARGET 3. FINANCIAL - OPERATING MARGIN MEETING AND/OR EXCEEDING VARIOUS TIERS A COUNTY OF CHRISTIAN KENTUCKY 616000824 170692CPO 2016-12-21 62052293 REFUND OUTSTANDING BONDS/CAPITAL false false false B COUNTY OF CHRISTIAN KENTUCKY 616000824 000000000 2022-11-29 32000000 REMODEL OF ER AND CANCER CENTER false false false A 1615000 0 62052293 4994713 0 45910620 1146961 0 0 10000000 0 0 2019 false true true true B 0 0 32000000 0 0 0 0 0 0 6908518 0 25091482 false false false true A false false true true false 0.00000 0.00000 0.00000 false false 0.00000 false true B false false true true false 0.00000 0.00000 0.00000 false false 0.00000 false true A false false false true false false 0 true NAXIS FUNDING GROUP 10.1 true false true B false false false true false false 0 true 0 true false true A true B true SCHEDULE K, PART I, COLUMN F PURPOSE OF THE BOND ------------------- 1. ADVANCE REFUNDING ON BONDS ISSUED 09/18/2008 2. CONSTRUCTION AND EQUIPPING OF THE CAPITAL ADDITIONS AND IMPROVEMENTS TO THE ORGANIZATION'S MAIN HOSPITAL CAMPUS AND AMBULATORY CARE CAMPUS SCHEDULE K, PART IV, LINE 2C REBATE COMPUTATION ------------------------------ THE ARBITRAGE REBATE CALCULATION WAS PERFORMED IN FEBRUARY 2022, COVERING THE PERIOD OF DECEMBER 21, 2016 TO JANUARY 31, 2022. NO ARBITRAGE REBATE LIABILITY HAS BEEN RECORDED AS A RESULT OF THE EVALUATION. FORM 990, PART VI, SECTION A, LINE 3 DELEGATION OF MANAGEMENT DUTIES ------------------------------- THE MEDICAL CENTER CONTRACTS WITH QUORUM HEALTH RESOURCES, LLC TO PROVIDE MANAGEMENT SERVICES UNDER AN AGREEMENT WHICH EXPIRES AUGUST 31, 2026. FORM 990, PART VI, SECTION B, LINE 11 REVIEW OF FORM 990 ------------------- THE ORGANIZATION ENGAGES AN OUTSIDE ACCOUNTING FIRM TO PREPARE ITS FORM 990. ONCE THE FORM 990 IS PREPARED BY THE ACCOUNTING FIRM AND REVIEWED BY MANAGEMENT, THE FINAL FORM IS PROVIDED TO THE ENTIRE BOARD OF DIRECTORS AT A REGULARLY SCHEDULED BOARD MEETING PRIOR TO FILING. QUESTIONS AND COMMENTS RAISED DURING THE MEETING REGARDING THE FINAL FORM 990 ARE ADDRESSED PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12B AND 12C MONITORING THE CONFLICT OF INTEREST POLICY ------------------------------------------ EACH OFFICER FROM DEPARTMENT MANAGER TO THE PRESIDENT, MEMBER OF MEDICAL STAFF, QUALIFIED PROFESSIONAL OR LICENSED INDEPENDENT PRACTITIONER, EACH MEMBER OF THE BOARD, AND EACH MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS MUST SIGN ANNUALLY A STATEMENT AND MAKE DISCLOSURES WHICH ARE PRESENTED TO THE BOARD FOR REVIEW, BEFORE THE FIRST BOARD MEETING OF EACH NEW YEAR. DOCUMENTATION OF THE ANNUAL BOARD REVIEW WILL BE RECORDED IN THE MINUTES. PERIODIC REVIEW SHALL BE CONDUCTED TO ENSURE THE MEDICAL CENTER OPERATES IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES AND THAT IT DOES NOT ENGAGE IN ACTIVITIES THAT COULD JEOPARDIZE ITS STATUS AS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX. FORM 990, PART VI, SECTION B, LINE 15A AND 15B PROCESS FOR DETERMINING COMPENSATION ------------------------------------- AN ANNUAL COMPENSATION REVIEW WAS CONDUCTED IN 2022 FOR THE ORGANIZATION'S TOP MANAGEMENT OFFICIALS AND OTHER OFFICERS AND KEY EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 MAKING DOCUMENTS AVAILABLE TO THE PUBLIC ----------------------------------------- THE HOSPITAL DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 8 RECONCILIATION OF NET ASSETS ---------------------------- OTHER CHANGES IN NET ASSETS: DISTRIBUTIONS TO NONCONTROLLING INTEREST $(211,560) ROUNDING $( 1) FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIANS/PROFESSIONAL SVCS TOTAL FEES:3922739 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACTED LAB SERVICES TOTAL FEES:1479903 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER FEES FOR SERVICES TOTAL FEES:17233118 FAIRVIEW PHYSICIANS NETWORK LLC 320 W 18TH STREET HOPKINSVILLE KY 42240 452032126 PHYSCIAN SRVS KY -8851590 0 JSMC WESTERN KENTUCKY MEDICAL DEVELOPMENTLLC PO BOX 2400 HOPKINSVILLE KY 42241 RENTAL KY JSMC JENNIE STUART HEALTH FOUNDATION PO BOX 608 HOPKINSVILLE KY 42241 822980765 SUPPORT KY 501(C)(3) 12B-11 JSMC true PHYSICIANS' HOLDINGS 320 W18 HOPKINSVILLE KY 42240 261608818 BUILDING RENT KY JSMC EXCLUDED 225177 1487182 false 0 false 0.57000 KENTUCKY HEALTHCARE HOLDINGS I LLC 109 WESTPARK DRIVE BRENTWOOD TN 37027 842468059 REAL ESTATE TN NA RELATED 45544 571111 false 0 false 0.50000 false false false false false false false false false true true false false false false false false true false PHYSICIANS' HOLDINGS LLC J 27272 FMV PHYSICIANS' HOLDINGS LLC K 559076 FMV