2024-05-15T10:09:19-05:00 2023-06-30 390859910 BAKER TILLY US LLP 1570 FRUITVILLE PIKE SUITE 400 LANCASTER PA 17601 990 2022-10-01 453215312 PORTSMOUTH HOSPITAL CORPORATION PORT 7409914000 1901 ARGONNE AVENUE PORTSMOUTH OH 45662 AUTUMN MCFANN TREASURER, SR VP/CFO/CAO 7409914000 2024-05-13 1 AUTUMN MCFANN 999009999 1 KERRI N BOGDA CPA P00760402 7177404863 2024-05-13 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z KING'S DAUGHTERS MEDICAL CENTER OHIO SARA MARKS 2201 LEXINGTON AVENUE ASHLAND KY 41101 28703872 0 X WWW.KINGSDAUGHTERSHEALTH.COM/LOCATIONS X 2010 OH TO CARE. TO SERVE. TO HEAL. 10 10 213 13 0 0 0 5376 38621799 28183898 -2114 2105 0 512493 38619685 28703872 1693 2590 0 0 13199632 10644210 0 0 0 13694576 10272563 26895901 20919363 11723784 7784509 26660626 28835305 3598967 2718778 23061659 26116527 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 18715781 2590 28183898 LOCATED IN PORTSMOUTH, OHIO, KING'S DAUGHTERS MEDICAL CENTER OHIO (PORTSMOUTH HOSPITAL CORPORATION) PROVIDES A COMFORTABLE, SMALL-HOSPITAL ENVIRONMENT WITH ACCESS TO TECHNOLOGY AND SPECIALISTS NORMALLY FOUND ONLY AT LARGER INSTITUTIONS.SERVING AS A HEALTHCARE CHOICE FOR RESIDENTS OF PORTSMOUTH, SCIOTO COUNTY AND SURROUNDING AREAS, KING'S DAUGHTERS MEDICAL CENTER OHIO (KDOH) PROVIDES SERVICES RANGING FROM PRIMARY CARE TO SURGICAL SERVICES; INPATIENT CARE TO OUTPATIENT DIAGNOSTICS; FROM SPECIALTY CARE TO URGENT CARE. CONTINUED ON SCHEDULE O.KING'S DAUGHTERS MEDICAL CENTER OHIO PROVIDES ACCESS TO THE FOLLOWING HEALTHCARE SERVICES: - PRIMARY CARE- URGENT CARE SERVICES AVAILABLE 24/7/365- SPECIALIST PHYSICIANS IN HEART AND VASCULAR; ORTHOPEDICS; DIGESTIVE HEALTH; GENERAL SURGERY; NEUROLOGY (EPILEPTOLOGIST); SURGICAL BREAST ONCOLOGY; PLASTIC & RECONSTRUCTIVE SURGERY; UROLOGY; ENT- INPATIENT SERVICES - SURGICAL CARE - IMAGING SERVICES, INCLUDING MRI, CT, NUCLEAR MEDICINE, 3D MAMMOGRAPHY, X-RAY, AND GENERAL AND VASCULAR ULTRASOUND - CARDIAC DIAGNOSTIC SERVICES, INCLUDING EKG, STRESS TESTING AND NUCLEAR MEDICINE - PULMONARY DIAGNOSTICS- NUTRITION COUNSELINGKDOH OFFERS FREE SCREENINGS IN HEART AND VASCULAR, SKIN CANCER, PROSTATE CANCER, AND ORTHOPEDIC SPECIALTIES; OFFERS A LOW-COST BLOOD PROFILE PROGRAM; PARTICIPATES IN AND SUPPORTS COMMUNITY EVENTS; PROVIDES ORTHOPEDIC TRAINERS IN SCHOOLS; AND PROVIDES A KIDS MOBILE FARMERS MARKET AT LOCAL SCHOOLS AND CIVIC ORGANIZATIONS. 18715781 1 1 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 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 213 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 BOARD CHAIRMAN 0.25 6.25 X X 0 0 0 DR MARK NEWMAN BOARD VICE-CHAIRMAN (UNTIL 12/31/22) 0.25 5.75 X X 0 0 0 PENNY COX DIRECTOR 0.25 2.25 X 0 0 0 GINA DUGAS DIRECTOR 0.25 2.25 X 0 0 0 ROBERT DIPAOLA DIRECTOR 0.25 2.25 X 0 0 0 JOHN STEWART DIRECTOR 0.25 2.75 X 0 0 0 TOM BURNETTE DIRECTOR 0.25 2.75 X 0 0 0 STEPHEN ADDINGTON DIRECTOR 0.25 2.50 X 0 0 0 ERIC MONDAY DIRECTOR 0.25 2.25 X 0 0 0 CRAIG COLLINS DIRECTOR 0.25 2.25 X 0 0 0 MARK BIRDWHISTELL DIRECTOR 0.25 2.25 X 0 0 0 KRISTIE WHITLATCH PRESIDENT/CEO (10/1/22-12/31/22) 1.25 60.75 X 0 0 0 SARA MARKS PRESIDENT/CEO (BEG. 1/1/23) 1.25 60.25 X 0 1844834 142949 AUTUMN MCFANN TREASURER, SR VP/CFO/CAO 1.25 60.25 X 0 1897128 131808 SHERYL MAHANEY UNTIL 113022 SECRETARY, VP/CHIEF LEGAL OFFICER 1.25 60.75 X 0 1518132 8395 STEVEN CLIFTON SECRETARY (BEG. 12/1/22) 0.25 5.75 X 0 0 0 AMY SAUNDERS ASSISTANT SECRETARY (BEG. 12/1/22) 0.25 45.75 X 0 227968 12371 TAMALA CONLEY EXECUTIVE DIRECTOR PHC 10.00 40.00 X 0 197260 39796 ROY ADAMS PHC MEDICAL DIRECTOR 0.50 40.00 X 3219 154470 24954 ELIZABETH HUFFMAN RN 25.00 15.00 X 79333 47951 21967 JAMES WHALEY APRN 10.00 30.00 X 34434 96900 22356 JAMES NEAL CNO 45.00 0.00 X 139156 0 34795 CRAIG HAZELBAKER PHARMACY SUPERVISOR 40.00 0.00 X 163377 0 25231 MELISSA WATSON PHARMACIST 40.00 0.00 X 171285 0 24152 590804 5984643 488774 9 0 1 0 BAYMARK MANAGEMENT SERVICES DEPT D8126 PO BOX 650002 DALLAS TX 75265 ADDICTION RECOVERY SERVICES 252843 TONY VIRGIN MD BOX 8 STATE ROUTE 141 KITTS HILL OH 45645 PHYSICIAN 205505 2 5376 5376 NET PATIENT REVENUE 621110 28003898 28003898 PHARMACY REVENUE 621110 180000 180000 28183898 2105 0 2105 2105 2105 QUALITY INCENTIVE 900099 512493 512493 512493 28703872 28183898 0 514598 2590 2590 7932693 7037092 895601 281251 249498 31753 1871521 1660226 211295 558745 477280 81465 181305 181305 908 908 1596061 1440103 155958 107752 80462 27290 424987 424987 2161 2148 13 5438 5438 1248864 1248864 49422 49422 MEDICAL SUPPLIES 3544797 3509381 35416 BAD DEBT EXPENSE 1746730 1746730 REPAIRS AND MAINTENANCE 1122703 1030697 92006 RENTAL FEES 119945 119945 121490 109857 11633 20919363 18715781 2203582 0 395199 429341 3538772 3152694 1708739 1593912 95619 200179 24299135 901172 20903398 23397963 18899 61216 26660626 28835305 2307884 1694251 1291083 1024527 3598967 2718778 X 23061659 26116527 23061659 26116527 26660626 28835305 X 7784509 -4729641 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 908 908 0 PART II-B, LINE 1: $908: A PORTION OF THE DUES PAID TO THE OHIO HOSPITAL ASSOCIATION ATTRIBUTABLE TO LOBBYING EXPENSES. 605910 605910 18356440 259171 18097269 5250 1525 3725 4731535 625324 4106211 600000 15152 584848 23397963 LEASE LIABILITY 50853 DUE TO MEDICARE 973674 1024527 1 1 X 1 X 1 X 1 1 0 1 1 83058 83058 0.00430 5296310 10283880 0 0.00000 5379368 10283880 83058 0.00430 94900 94900 0.00490 23531 23531 0.00120 118431 118431 0.00610 5497799 10283880 201489 0.01040 1 664862 3056128 3407033 -350905 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 21 1 1 0 1 X HTTPS://WWW.KINGSDAUGHTERSHEALTH.COM/DOCUMENTS/COMMUNITY/KDOH-2022-COMMUNIT X 1 22 1 HTTPS://WWW.KINGSDAUGHTERSHEALTH.COM/DOCUMENTS/COMMUNITY/KD-OHIO-CHNA-IMPLE 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 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 11: THE 2021-22 COMMUNITY HEALTH NEED ASSESSMENT IDENTIFIED THE FOLLOWING NEEDS THAT THE MEDICAL CENTER WILL BE ADDRESSING:- CHRONIC CONDITIONS: BREAST AND COLON CANCERS- PREVENTIVE CARE: PHYSICAL ACTIVITY/WELLNESS, MENTAL HEALTH, NUTRITIONCHRONIC CONDITIONS:BREAST CANCER: KDOH WILL BE ADDRESSING BREAST CANCER THROUGH INCREASING SCREENING MAMMOGRAMS TO HELP IN EARLY IDENTIFICATION AND DIAGNOSIS OF BREAST CANCER. EARLY IDENTIFICATION AND TREATMENT REDUCE THE BURDEN OF BREAST CANCER AND IMPROVE PATIENT OUTCOMES.COLON CANCER: COLON CANCER WILL BE ADDRESSED BY INCREASING EDUCATION ABOUT COLON CANCER AND THE NEED FOR SCREENING AMONG THOSE 45 YEARS OF AGE AND OLDER. THE EARLIER COLON CANCER IS DETECTED THE BETTER THE PATIENT OUTCOMES.PREVENTIVE CARE: PHYSICAL ACTIVITY/WELLNESS: KDOH WILL PROVIDE COMMUNITY EDUCATION FOCUSED ON HEALTHY LIFESTYLES AND WELLNESS. AS PART OF THIS PRIORITY, KDOH PLANS TO HOST OR SPONSOR AT LEAST FOUR EVENTS PROMOTING PHYSICAL ACTIVITY, ESPECIALLY FOR CHILDREN. IN ADDITION, KDOH WILL HOST AT LEAST SIX HEALTH SCREENING ACTIVITIES RELATED TO BLOOD PRESSURE, CHOLESTEROL, BLOOD SUGAR, NUTRITION AND NICOTINE EDUCATION.MENTAL HEALTH: KDOH PLANS TO PROVIDE COMMUNITY EDUCATION REGARDING THE SUICIDE PREVENTION HOTLINE AND MENTAL HEALTH AWARENESS. IN ADDITION, KDOH WILL PARTNER WITH KDMC TO PUBLISH SOCIAL MEDIA POSTS FOCUSED ON MENTAL HEALTH ON KDOH'S SOCIAL MEDIA PAGES. NUTRITION: KDOH WILL PROVIDE COMMUNITY EDUCATION ON HEALTHY EATING AND EDUCATIONAL PROGRAMS FOCUSED ON NUTRITION. THIS WILL BE DONE THROUGH THE MOBILE MARKET AND OTHER OPPORTUNITIES. KDOH WILL PARTICIPATE IN AT LEAST FOUR EVENTS, OF WHICH TWO WILL FOCUS ON SENIOR CITIZENS. THE IDENTIFIED NEEDS OF OVERWEIGHT/OBESITY, DIABETES, AND HEART DISEASE ARE BEING ADDRESS WITHIN THE PREVENTIVE CARE INITIATIVES. THE IDENTIFIED NEEDS OF SUBSTANCE USE DISORDER, RESPIRATORY ILLNESSES, INFANT HEALTH AND FAMILY PLANNING, INJURY AND VIOLENCE, KIDNEY DISEASE, ORAL HEALTH, POTENTIALLY DISABLING CONDITIONS, RESPIRATORY DISEASE, AND TOBACCO USE ARE OUTSIDE THE SCOPE OF SERVICES PROVIDED BY KDOH. THERE ARE ALSO OTHER ORGANIZATIONS IN THE KDOH SERVICE AREA THAT PROVIDE SERVICES TO ADDRESS THESE NEEDS. PORTSMOUTH HOSPITAL CORP DBA KDMC OHIO PART V, SECTION B, LINE 24: FAP ELIGIBLE PATIENTS ARE CHARGED THE GROSS CHARGE FOR ANY SERVICES EXCLUDED FROM ELIGIBILITY AS DEFINED WITHIN THE FAP, WHICH ARE DEFINED AS ELECTIVE SERVICES AND THEREFORE NOT MEDICALLY NECESSARY. PART I, LINE 7: KDOH USED WORKSHEET 2 PROVIDED IN THE SCHEDULE H INSTRUCTIONS (FORM 990) TO CALCULATE A COST TO 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 $1,746,730. 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: BAD DEBT EXPENSE IS RECORDED AFTER ANY DISCOUNTS AND PAYMENTS ARE MADE ON PATIENT ACCOUNTS. HOWEVER, THE BUSINESS OFFICE DOES NOT KEEP TRACK OF "NO-RESPONSE" APPLICATIONS AND DOES NOT FEEL THAT THE PORTION CONSIDERED TO BE A COMMUNITY BENEFIT IS MATERIAL. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE ARE REPORTED AT NET REALIZABLE VALUE. ACCOUNTS ARE WRITTEN OFF WHEN THEY ARE DETERMINED TO BE UNCOLLECTIBLE BASED UPON MANAGEMENT'S ASSESSMENT OF INDIVIDUAL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THE MEDICAL CENTER ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SERVICE PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE MEDICAL CENTER ANALYZES CONTRACTUAL AMOUNTS DUE AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND INSURED PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES), THE MEDICAL CENTER RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY REPONSIBLE. THE DIFFERENCE BETWEEN THE BILLED RATES AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. 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 HOSPITAL A DISSERVICE. THIS SHORTFALL SHOULD COUNT AS A COMMUNITY BENEFIT. THE HOSPITAL USES ALLOWABLE COSTS PER THE MEDICARE COST REPORT. THE 2023 MEDICARE COST REPORT DATA WAS USED TO COMPUTE THE INFORMATION. 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 POVERTY LEVEL 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: KDOH'S SERVICE AREA OF 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. OTHER NOTABLE CITIES IN SCIOTO COUNTY ARE WHEELERSBURG, LUCASVILLE, AND NEW BOSTON. ACCORDING TO THE US CENSUS BUREAU 2020 AMERICAN COMMUNITY SURVEY, SCIOTO COUNTY HAS 74,008 RESIDENTS. OF THE RESIDENTS, 94.4% ARE WHITE, 2.7% BLACK, AND 2.9% REPRESENT ALL OTHER RACES. OF THE POPULATION, 1.4% CLAIM HISPANIC/LATINO ETHNICITY. FORTYNINE AND ONE-HALF PERCENT OF THE POPULATION IS MALE AND 50.5% 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, 84.9% HAVE GRADUATED HIGH SCHOOL, COMPARED TO 90.4% IN OHIO AND 88% NATIONALLY. ONLY 15.7% OF SCIOTO COUNTY RESIDENTS HAVE A BACHELOR'S DEGREE OR HIGHER COMPARED TO OHIO (28.3%) AND THE UNITED STATES (32.1%). THE POPULATION OF SCIOTO COUNTY IS MADE UP OF 5.8% CHILDREN UNDER FIVE; 21.6% CHILDREN/YOUTH UNDER AGE 18; 54.0% AGE 18-64; AND 18.6% OVER THE AGE OF 65. 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 22.8% IS HIGHER THAN OHIO (12.6%) AND THE NATION (11.4%). THE MEDIAN INCOME FOR THE COUNTY IS $41,330, WHICH IS WELL BELOW THE STATE ($56,602) AND NATION ($62,843). 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 2020 AMERICAN COMMUNITY SURVEY DATA SHOWS THAT AMONG THOSE UNDER AGE 65, 8.3% HAVE NO HEALTH INSURANCE, COMPARED TO 7.8% IN OHIO AND 10.2% NATIONWIDE. PART VI, LINE 5: KDOH PROVIDES FREE EDUCATIONAL AND SCREENING SERVICES IN SCIOTO COUNTY, THE PRIMARY MARKET. KDOH WORKS WITH 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 201 PROVIDED- HEALTHY HEART SCREENING 125 SERVED- MOBILE MAMMOGRAPHY 152 SERVED- SPORTS PHYSICALS 143 SERVED- LOW-COST BLOOD PROFILES 561 SERVED- BLOOD PRESSURE SCREENING 58 SERVEDHEALTH EDUCATION:- 988 SUICIDE HELP LINE 233- AED 14 SERVED- BONE HEALTH 341 SERVED- BREAST CANCER 634 SERVED- CONGESTIVE HEART FAILURE 92 SERVED- COLON CANCER 729 SERVED- DENTAL HEALTH 36 SERVED- DIABETES 1,036 SERVED- FIT TESTING 14 SERVED- FLU EDUCATION 123 SERVED- HANDWASHING 1,119 SERVED- HANDS ONLY CPR 363 SERVED- HEART 1,280 SERVED- HYPERTENSION 112 ADULTS SERVED- IMMUNIZATION 216 SERVED - LUNG CANCER 128 ADULTS SERVED- NUTRITION 1,638 SERVED- PHYSICAL ACTIVITY 546 SERVED- SKIN CANCER 768 SERVED- SUMMER SAFETY 194 SERVED- TOBACCO, SMOKELESS TOBACCO/VAPING 1,546 SERVEDOTHER COMMUNITY ACTIVITIES:BLOOD DRIVES - KDOH PARTNERED WITH THE RED CROSS TO INCREASE BLOOD DONATIONS BY ENCOURAGING TEAM MEMBERS TO PARTICIPATE IN LOCAL BLOOD DRIVES DURING WORK HOURS. 26 DONATIONS WERE PROVIDED.BACKPACK PROGRAM - TEAM MEMBERS DONATED OVER 300 ITEMS OF SCHOOL AND DISINFECTING SUPPLIES TO PORTSMOUTH ELEMENTARY SCHOOL CHILDREN TO ENSURE STUDENTS START THE YEAR WITH THE NECESSARY SCHOOL SUPPLIES.ADOPT-A-FAMILY - TEAM MEMBERS ADOPTED TWO FAMILIES WITH A TOTAL OF 10 FAMILY MEMBERS AT CHRISTMAS PROVIDING GIFTS AND FOOD.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 1 0 0 0 0 0 1 0 AUTUMN MCFANN TREASURER, SR VP/CFO/CAO 0 480101 0 138000 0 1279027 0 113725 0 18083 0 2028936 0 50000 SARA MARKS PRESIDENT/CEO (BEG. 1/1/23) 0 464919 0 133500 0 1246415 0 113725 0 29224 0 1987783 0 50000 SHERYL MAHANEY UNTIL 113022 SECRETARY, VP/CHIEF LEGAL OFFICER 0 307303 0 0 0 1210829 0 0 0 8395 0 1526527 0 0 AMY SAUNDERS ASSISTANT SECRETARY (BEG. 12/1/22) 0 190304 0 37219 0 445 0 10268 0 2103 0 240339 0 0 TAMALA CONLEY EXECUTIVE DIRECTOR PHC 0 157493 0 38384 0 1383 0 9053 0 30743 0 237056 0 0 MELISSA WATSON PHARMACIST 168551 0 2615 0 119 0 7753 0 16399 0 195437 0 0 0 CRAIG HAZELBAKER PHARMACY SUPERVISOR 154864 0 7804 0 709 0 7427 0 17804 0 188608 0 0 0 ROY ADAMS PHC MEDICAL DIRECTOR 3219 153676 0 0 0 794 0 7006 0 17948 3219 179424 0 0 JAMES NEAL CNO 126129 0 12677 0 350 0 6343 0 28452 0 173951 0 0 0 JAMES WHALEY APRN 34427 95513 0 1371 7 16 5957 0 16399 0 56790 96900 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/COMPENSATION COMMITTEE. PART I, LINES 4A-B THE FOLLOWING INDIVIDUALS RECEIVED CHANGE IN CONTROL PAYMENTS: - SHERYL MAHANEY: $1,209,162 - SARA MARKS: $1,175,614 - AUTUMN MCFANN: $1,208,771 THESE WERE PAID AS A RESULT OF THE 12/1/22 MEMBER SUBSTITUTION WITH THE UNIVERSITY OF KENTUCKY. THE FOLLOWING INDIVIDUALS RECEIVED PAYMENTS FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: - AUTUMN MCFANN: $18,996 - SARA MARKS $19,541 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. THE FOLLOWING INDIVIDUALS RECEIVED 457(F) EXECUTIVE RETENTION PLAN PAYOUTS: - AUTUMN MCFANN: $50,000 - SARA MARKS: $50,000 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 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 MANAGED AS AN AGENDA ITEM BY THE FULL BOARD INDEPENDENTLY OR THROUGH ITS COMMITTEE STRUCTURE. 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 CFO 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 PAYABLE -8,214,080. FASB TO GASB CONVERSION 3,484,439. 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 425 22ND STREET ASHLAND KY 41101 264736971 MEDICAL TRANSPORT KY 501(C)(3) LINE 10 ASHLAND HOSPITAL COPORATION 0 KING'S DAUGHTERS HEALTH SYSTEM 2201 LEXINGTON AVENUE ASHLAND KY 41101 274553836 HEALTHCARE KY 501(C)(3) LINE 12B, II N/A 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 FOUNDATION INC 2201 LEXINGTON AVENUE ASHLAND KY 41101 611035701 FUNDRAISING 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