2024-02-14T08:51:58-06:00 2023-03-31 FORVIS LLP 1222 Demonbreun Street Suite 950 Nashville TN 372033357 990 2022-04-01 611362000 COMMONWEALTH HEALTH FOUNDATION INC MED CENTER HEALTH FOUNDATION % JENNY GREENWELL COMM 2707451551 800 PARK STREET BOWLING GREEN KY 42101 MICHELE LAWLESS EVP - CFO 2707451551 2024-02-15 true MICHELE LAWLESS 999009999 JEFF SMITH P00289876 6159883600 3 2022 2023-04-26 12:10:37Z CONNIE D SMITH 800 PARK STREET BOWLING GREEN KY 42101 16578981 false X HTTPS://MEDCENTERHEALTH.ORG/FOUNDATION X 2000 KY FOSTERING, SUPPORTING, AND INITIATING ACTIVITIES FOR THE ADVANCEMENT OF HEALTHCARE OBJECTIVES OF NOT-FOR- PROFIT MED CENTER HEALTH AND ITS AFFILIATES. 15 11 0 120 0 0 1534129 1623906 0 0 2911081 -1638830 6335 -59878 4451545 -74802 1506707 1465651 0 0 0 0 0 0 0 391298 412078 1898005 1877729 2553540 -1952531 18360282 16902026 37877 6775 18322405 16895251 X THE FOUNDATION BUILDS RELATIONSHIPS THAT INSPIRE CHARITABLE GIVING IN SUPPORT OF MED CENTER HEALTH'S MISSION TO CARE FOR PEOPLE AND IMPROVE THE QUALITY OF LIFE IN THE COMMUNITIES WE SERVE. false false 1870215 1465651 COMMONWEALTH HEALTH FOUNDATION, INC (CHF) WORKS TO CHANGE LIVES EVERY DAY AND CAN ONLY DO SO WITH THE SUPPORT OF DEDICATED, COMPASSIONATE PEOPLE FROM THE COMMUNITY. CHF HOSTS A VARIETY OF EVENTS THROUGHOUT THE YEAR TO RAISE AWARENESS & SUPPORT. CHF IS OWNED AND CONTROLLED BY COMMONWEALTH HEALTH CORPORATION (CHC), A RELATED 501(c)(3) ORGANIZATION. SINCE CHC COVERS THE FOUNDATION'S OPERATING EXPENSES, 100% OF ALL DONATIONS GO DIRECTLY TO IMPROVE LIVES IN OUR COMMUNITY. SEE SCHEDULE O FOR MORE INFORMATION. 1870215 true true false false false false false false false true true false false false true false false true false false false false false false true false false true false true false false false false false false false false true false false false false true false false false true X 12 0 true 0 false false false false false true true false false false false false false X 15 11 false false false false true true false true true false false true true true true true true false false false KY X JENNY GREENWELL 2707451551 800 PARK STREET BOWLING GREEN KY 42101 CONNIE D SMITH PRESIDENT / CEO 2.0 52.0 X X 0 1285993 20191 WADE STONE EXECUTIVE VICE PRESIDENT 2.0 50.0 X 0 501132 20005 DAVID GRAY EVP / DESIGNEE FOR J. NATCHER 2.0 50.0 X X 0 385152 43999 MICHELE W LAWLESS SEC/TREAS & EXEC VP - CFO 2.0 50.0 X X 0 421749 3491 KATRINA WOOD VP/CHIEF NURSING OFFICER 2.0 50.0 X 0 219378 35340 DR NISAR KAZIMUDDIN DIRECTOR/PHYS.- ENDED 12/31/22 2.0 0.0 X 0 81200 0 DR JACQUELINE DAWSON DOWE DIRECTOR / PHYSICIAN 2.0 0.0 X 0 50000 0 MIKE COWLES CHAIR 2.0 0.0 X X 0 0 0 DR DONNA BLACKBURN DIRECTOR 2.0 4.0 X 0 0 0 REGINA PARSLEY-BYRD DIRECTOR - ENDED 12/31/22 2.0 0.0 X 0 0 0 MAYOR RANDALL CURRY DIRECTOR 2.0 0.0 X 0 0 0 CHRIS GUTHRIE DIRECTOR 2.0 0.0 X 0 0 0 BEVERLY HODGES DIRECTOR 2.0 0.0 X 0 0 0 DARLENE JOHNSON DIRECTOR - ENDED 12/31/22 2.0 0.0 X 0 0 0 G MICHAEL MURPHY DIRECTOR 2.0 0.0 X 0 0 0 CHERI NATCHER DIRECTOR 2.0 4.0 X 0 0 0 JILL SORRENTINO DIRECTOR 2.0 0.0 X 0 0 0 TONY WITTY DIRECTOR 2.0 2.0 X 0 0 0 DARREN WOODRUFF DIRECTOR - ENDED 12/31/22 2.0 0.0 X 0 0 0 JOHN KELLY VICE-CHAIR 2.0 0.0 X X 0 0 0 SHANNON MAGLINGER DIRECTOR - RESIGNED 10/18/22 2.0 0.0 X 0 0 0 DR WILLIAM MOSS DIRECTOR 2.0 2.0 X 0 0 0 0 2944604 123026 0 false true false 0 349274 570403 704229 54702 1623906 0 269793 269793 0 0 11460 11460 0 11460 11460 14588749 16497372 -1908623 -1908623 -1908623 85073 349274 156411 -71338 -71338 0 0 0 0 0 0 0 -74802 -1698708 1463151 1463151 2500 2500 0 0 0 0 0 0 0 0 0 0 4399 4399 0 0 0 328006 328006 38212 38212 32921 32814 107 0 0 0 1534 1534 0 0 0 0 0 5532 5532 DUES & SUBSCRIPTIONS 1474 1474 1877729 1870215 7514 0 80714 105852 0 0 214378 64662 0 0 0 0 0 0 0 0 0 0 1976 8641 6263 6263 18034164 16721733 0 0 0 0 0 0 29050 1138 18360282 16902026 9117 5637 0 0 0 0 0 0 0 0 0 0 0 0 0 0 28760 1138 37877 6775 X 17695519 16268365 626886 626886 18322405 16895251 18360282 16902026 X -1952531 497830 27547 X false true X true false X 1103827 1416603 2177796 1534129 1623906 7856261 0 0 1103827 1416603 2177796 1534129 1623906 7856261 0 7856261 68520 73082 61370 78581 269793 551346 0 57600 58321 23750 85073 224744 8632351 0.91009 0.93080 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 18034164 -1284343 28088 16721733 16610096 -145000 1601378 32310 18034164 12081597 290000 4264794 26295 16610096 12986522 -879883 25042 12081597 12853542 221884 -64158 24746 12986522 1.00000 false false 6263 6263 0 0 0 PAYABLE TO AFFILIATES 1138 1138 612949 497830 189921 687751 -74802 -74802 2034140 156411 156411 1877729 1877729 SCH D, PART V, LINE 4 -------------------------- WITH AN INTENT TO BUILD PERMANENT ENDOWMENTS FROM WHICH ONLY THE EARNINGS OR CAPITAL APPRECIATION IS USED, THE FOUNDATION'S ANNUAL COMMUNITY SERVICE INCLUDES SUPPORT OF THE COMMONWEALTH HEALTH FREE CLINIC, COMMONWEALTH HEALTH CORPORATION AND IT'S AFFILIATES, AND VARIOUS SCHOLARSHIP PROGRAMS. SCH D, PART X, LINE 2 INCOME TAXES -------------- THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS DID NOT INCLUDE A FOOTNOTE THAT ADDRESSED THE ORGANIZATION'S LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER FIN 48 (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. SCH D, PART XI, LINE 2D OTHER ADJUSTMENTS ------------------------------------------- CHANGE IN BENEFICIAL INTEREST $ 33,510 FUNDRAISING EXPENSES INCLUDED IN REVENUE $ 156,411 --------- TOTAL $ 189,921 SCH D, PART XII, LINE 2D OTHER ADJUSTMENTS ------------------------------------------- FUNDRAISING EXPENSES INCLUDED IN REVENUE $ 156,411 CHARITY BALL 434347 349274 85073 69090 87321 0 434347 349274 85073 69090 87321 156411 -71338 true COMMONWEALTH HEALTH CORPORATION 800 PARK STREET BOWLING GREEN KY 42101 311118087 501(C)(3) 288883 GENERAL SUPPORT COMMONWEALTH HEALTH FREE CLINIC 800 PARK STREET BOWLING GREEN KY 42101 611292739 501(C)(3) 926813 GENERAL SUPPORT BOWLING GREEN WARREN COUNTY COMMUNITY HOSPITAL 800 PARK STREET BOWLING GREEN KY 42101 610920842 501(C)(3) 194740 GENERAL SUPPORT THE MEDICAL CENTER AT FRANKLIN 800 PARK STREET BOWLING GREEN KY 42101 611362001 501(C)(3) 6658 GENERAL SUPPORT THE MEDICAL CENTER AT CLINTON COUNTY 800 PARK STREET BOWLING GREEN KY 42101 811312058 501(C)(3) 10861 GENERAL SUPPORT 5 SCH I, PART I, LINE 2 ----------------------------------------- COMMONWEALTH HEALTH FOUNDATION HELPS TO BUILD RELATIONSHIPS AND PARTNERSHIPS ACROSS SOUTH CENTRAL KENTUCKY THAT WILL INSPIRE CHARITABLE GIVING BY INDIVIDUALS, FOUNDATIONS, CORPORATIONS, AND ORGANIZATIONS. THESE GIFTS HELP TO SUPPORT THE MISSION OF MED CENTER HEALTH TO CARE FOR PEOPLE AND IMPROVE THE QUALITY OF LIFE IN THE COMMUNITIES WE SERVE. COMMONWEALTH HEALTH FOUNDATION'S PHILANTHROPIC PROGRAM IS CURRENTLY FOCUSED ON ATTRACTING NATIONAL, REGIONAL, AND LOCAL SUPPORT FOR THE COMMONWEALTH HEALTH FREE CLINIC. COMMONWEALTH HEALTH FREE CLINIC ("CHFC") WAS ORGANIZED TO OPERATE A CLINIC, WHICH PROVIDES BASIC MEDICAL AND DENTAL DIAGNOSTIC AND TREATMENT SERVICES FOR CHARITABLE PURPOSES FOR THE UNINSURED AND UNDERINSURED OF SOUTH-CENTRAL KENTUCKY AND ALSO SERVES INDIVIDUALS WHO MAY BE COVERED BY SOME FORM OF INSURANCE, BUT WHO ARE UNABLE TO ACCESS A PROVIDER FOR ACUTE OR CHRONIC HEALTHCARE ISSUES. THE CLINIC OFFERS SERVICES INCLUDING NON-EMERGENCY CLINICAL SERVICES, DENTISTRY, COMMUNITY HEALTH EDUCATION AND COUNSELING, DISEASE/CONDITION SPECIFIC EDUCATION AND COUNSELING, AND ACCESS TO PHARMACEUTICALS. DISTINCT RECORDS ARE MAINTAINED ON THE ACTIVITIES OF THE CORPORATION AND THE COMMONWEALTH HEALTH FREE CLINIC. SUCH RECORDS OF SERVICES PROVIDED, FUNDS RECEIVED, AND THE USE OF THE FUNDS RECEIVED ARE REVIEWED BY THE CORPORATE BOARD. ANNUALLY, A REPORT IS PREPARED AND SHARED WITH THE COMMUNITY/DONORS. false true false false false false false false false DAVID GRAY EVP / DESIGNEE FOR J. NATCHER 0 376518 0 0 0 8634 0 9150 0 34849 0 429151 0 0 MICHELE W LAWLESS SEC/TREAS & EXEC VP - CFO 0 415047 0 0 0 6702 0 0 0 3491 0 425240 0 0 CONNIE D SMITH PRESIDENT / CEO 0 992844 0 0 0 293149 0 0 0 20191 0 1306184 0 0 WADE STONE EXECUTIVE VICE PRESIDENT 0 471203 0 0 0 29929 0 0 0 20005 0 521137 0 0 KATRINA WOOD VP/CHIEF NURSING OFFICER 0 216316 0 0 0 3062 0 5519 0 29821 0 254718 0 0 SCH J, PART I, LINE 4B ---------------- CERTAIN EXECUTIVES OF COMMONWEALTH HEALTH CORPORATION PARTICIPATE IN A SUPPLEMENTAL RETIREMENT PLAN. THE CURRENT YEAR INCREASE IN THE ACCRUED BENEFIT, AS ACTUARIALLY DETERMINED, IS REPORTED AS COMPENSATION. THE FOLLOWING ARE THE INDIVIDUALS PARTICIPATING IN THE PLAN AND THE CURRENT YEAR INCREASES REPORTED AS COMPENSATION: CONNIE SMITH $274,682 WADE STONE $ 27,694 SCH J, PART I, LINE 3 ---------------- THE CEO IS COMPENSATED BY COMMONWEALTH HEALTH CORPORATION (CHC), A RELATED ORGANIZATION. CHC USES THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF THE CEO: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE X PRIZES 11 54702 FMV false true false FORM 990, PART III, LINE 4A PROGRAM SERVICE ACCOMPLISHMENTS ----------------------------------- CONTRIBUTIONS TO THE FOUNDATION SERVE THE COMMUNITY BY SUPPORTING SERVICES SUCH AS: - THE COMMONWEALTH HEALTH FREE CLINIC, INC., PROVIDING MEDICAL AND DENTAL ASSISTANCE - THE BARREN RIVER REGIONAL CANCER CENTER, INC (BRRCC), PROVIDING TRANSPORTATION FOR CANCER PATIENTS SO THEY CAN RECEIVE THEIR TREATMENTS AND MAKING SURE THEY CAN GET THE MEDICATIONS THEY NEED FOR A SUCCESSFUL OUTCOME - HOSPITALITY HOUSE, PROVIDING A "HOME-AWAY-FROM-HOME" FOR CAREGIVERS OF PATIENTS WITH EXTENDED HOSPITAL STAYS - THE MEDICAL CENTER-WKU HEALTH SCIENCES COMPLEX SIMULATION LAB, SUPPORTING INNOVATION AND PRODUCT DEVELOPMENT AS WELL AS ADVANCED KNOWLEDGE IN PATIENT CARE - GUARDIAN ANGEL CHILDREN'S SERVICES, A PROGRAM THAT BENEFITS CHILDREN UNDER THE AGE OF 18 WHO LIVE IN SOUTH CENTRAL KENTUCKY AND HAVE SPECIFIC MEDICAL OR DENTAL NEEDS FORM 990, PART VI, SECTION A, LINE 6 MEMBERS --------- THE ARTICLES/BYLAWS OF THE CORPORATION PROVIDE FOR A MEMBER, THE ROLE OF WHICH IS FILLED BY COMMONWEALTH HEALTH CORPORATION. THE BYLAWS STATE THE APPROVED NOMINEES FOR DIRECTOR SHALL BE SUBMITTED TO THE BOARD OF DIRECTORS OF COMMONWEALTH HEALTH CORPORATION. NOTWITHSTANDING ANY TERMS OR CONDITIONS CONTAINED HEREIN RELATIVE TO NUMBERS, CLASSES OR TERMS OF DIRECTORS, THE CHAIRMAN OF COMMONWEALTH HEALTH CORPORATION BOARD OF DIRECTORS OR HIS/HER DESIGNEE, THE CHIEF EXECUTIVE OFFICER OF THE MEDICAL CENTER, THE CHIEF EXECUTIVE OFFICER OF COMMONWEALTH HEALTH CORPORATION OR HIS/HER DESIGNEE AND THE CHIEF FINANCIAL OFFICER OF THE MEDICAL CENTER SHALL BE EX OFFICIO DIRECTORS, SHALL BE COUNTED FOR QUORUM PURPOSES AND SHALL HAVE ALL THE RIGHTS AND PRIVILEGES OF OTHER DIRECTORS INCLUDING THE RIGHT TO VOTE ON ALL MATTERS PROPERLY BEFORE THE BOARD. FORM 990, PART VI, SECTION A, LINE 7A POWER OF MEMBERS ------------------ THE FOUNDATION'S BYLAWS ALLOW THE PARENT, COMMONWEALTH HEALTH CORPORATION, FINAL APPROVAL OR REJECTION OF ALL BOARD MEMBERS OF THE FOUNDATION. FORM 990, PART VI, SECTION B, LINE 11B PROCESS TO REVIEW FORM 990 ----------------------------- FORM 990 IS PLACED ELECTRONICALLY ON A COMPANY WEBSITE USED TO SHARE INFORMATION WITH BOARD MEMBERS. EACH BOARD MEMBER IS PROVIDED ACCESS TO THIS WEBSITE AND IS ASKED TO REVIEW FORM 990 PRIOR TO A DESIGNATED DATE ON WHICH THE RETURN WILL BE FILED. ADVANCE NOTICE IS GIVEN TO BOARD MEMBERS SO THEY MAY REVIEW THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C MONITORING THE CONFLICT OF INTEREST POLICY -------------------------------------------- THE COMMONWEALTH HEALTH CORPORATION (CHC) (APPLICABLE TO THE CORPORATION AND/OR ITS AFFILIATES) CODE OF CONDUCT EXPLICITLY STATES MEMBERS OF THE BOARD, ADMINISTRATION, THE MEDICAL STAFF AND ALL EMPLOYEES ARE EXPECTED TO AVOID CONFLICT OF INTEREST. FURTHER, IT REQUIRES DISCLOSURE OF ANY POTENTIAL CONFLICTS OF INTEREST IN A TIMELY MANNER. ALL INDIVIDUALS SIGN AN ACKNOWLEDGEMENT UPON EMPLOYMENT THAT THEY HAVE RECEIVED A COPY OF THE CODE OF CONDUCT, ARE FAMILIAR WITH ITS CONTENT, AND UNDERSTAND THEIR RESPONSIBILITIES TO AVOID NONCOMPLIANT ACTIVITY. CHC'S REGULATORY COMPLIANCE AND COMPENSATION COMMITTEE (RCC) REVIEWS AND APPROVES ALL CONTRACTS BETWEEN CHC AND/OR ITS AFFILIATES AND DISQUALIFIED ENTITIES. THE REVIEW IS DESIGNED TO IDENTIFY POTENTIAL CONFLICTS OF INTEREST BY BOARD MEMBERS AND/OR OFFICERS. RCC MEMBERS ARE PROHIBITED FROM TAKING PART IN DECISIONS REGARDING TRANSACTIONS WITH WHICH HE/SHE HAS A CONFLICT OF INTEREST. ANNUALLY, WRITTEN INQUIRY IS MADE BY QUESTIONNAIRE OF BOARD MEMBERS AND OFFICERS SEEKING DISCLOSURE OF CONFLICTS OF INTEREST OF INFORMATION THAT RELATES TO FAMILY MEMBERS. TRANSACTIONS ARISING ARE REVIEWED BY MANAGEMENT AS THEY OCCUR. FORM 990, PART VI, SECTION B, LINE 15 DETERMINING COMPENSATION --------------------------- COMMONWEALTH HEALTH FOUNDATION IS PART OF AN INTEGRATED HEALTHCARE DELIVERY SYSTEM WHOSE PARENT IS COMMONWEALTH HEALTH CORPORATION, INC (CHC). COMPENSATION FOR ALL AFFILIATES IS OVERSEEN AND COORDINATED THROUGH CHC. CHC USES INDEPENDENT CONSULTANTS TO ANNUALLY REVIEW COMPENSATION. COMPENSATION-RELATED DETERMINATIONS ARE CONDUCTED IN ACCORDANCE WITH APPLICABLE REQUIREMENTS OF THE INTERNAL REVENUE CODE AND REGULATIONS TO QUALIFY FOR THE PRESUMPTION THAT THE COMPENSATION IS REASONABLE, INCLUDING BUT NOT LIMITED TO APPROVAL BY AN AUTHORIZED COMMITTEE OF THE BOARD OF DIRECTORS WHO DO NOT HAVE A CONFLICT OF INTEREST, OBTAINING AND RELYING ON APPROPRIATE DATA AS TO COMPARABILITY, AND CONCURRENT DOCUMENTATION OF THE BASIS FOR THE COMPENSATION DETERMINATIONS. FORM 990, PART VI, SECTION C, LINE 19 MAKING DOCUMENTS AVAILABLE TO THE PUBLIC ------------------------------------------ GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE ONLY MADE AVAILABLE IF REQUIRED, AND IN THE MANNER REQUIRED, BY A GOVERNING AGENCY. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS ------------------------------- TRANSFERS FROM AFFILIATES $ 8,475 CHANGE IN BENEFICIAL INTEREST $33,510 ADJUSTMENT FOR DONOR RESTRICTED ASSETS ($14,438) ------------ TOTAL $27,547 FORM 990, PART XII, LINE 2C OVERSIGHT PROCESS -------------------- THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT. NO PROCESSES HAVE CHANGED FROM PRIOR YEAR. FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT FEES TOTAL FEES:42947 FORM 990 PART IX LINE 11G DESCRIPTION:EMPLOYEE SUPPORT FEES TOTAL FEES:285059 BOWLING GREEN WARREN COUNTY COMMUNITY 800 PARK STREET BOWLING GREEN KY 42101 610920842 HOSPITAL KY 501(C)(3) 3 CHC INC false COMMONWEALTH REGIONAL SPECIALTY HOSPITAL 800 PARK STREET BOWLING GREEN KY 42101 542142034 HOSPITAL KY 501(C)(3) 3 CHC INC false COMMONWEALTH HEALTH FREE CLINIC INC 800 PARK STREET BOWLING GREEN KY 42101 611292739 HEALTHCARE KY 501(C)(3) 3 CHC INC false THE MEDICAL CENTER AT FRANKLIN 800 PARK STREET BOWLING GREEN KY 42101 611362001 HOSPITAL KY 501(C)(3) 3 CHC INC false THE MEDICAL CENTER AT ALBANY 800 PARK STREET BOWLING GREEN KY 42101 811312058 HOSPITAL KY 501(C)(3) 3 CHC INC false COMMONWEALTH HEALTH CORPORATION 800 PARK STREET BOWLING GREEN KY 42101 311118087 SUPPORT KY 501(C)(3) 10 NA false MEDICAL PLAZA PARTNERS LTD 800 PARK STREET BOWLING GREEN KY 42101 611080340 REAL ESTATE KY NA none 0 0 false 0 false true false false false false false false false false false true false true false true true true true