2025-11-14T10:54:22-06:00 2024-12-31 351178661 BLUE & CO LLC 2650 EASTPOINT PKWY SUITE 300 LOUISVILLE KY 40223 990 2024-01-01 610518022 LIVINGSTON HOSPITAL & HEALTHCARE SERVICES INC LIVI 2709882299 131 HOSPITAL DRIVE SALEM KY 42078 DAN KLIDZEJS CFO 2709882299 2025-11-11 1 1 EMILIE M KNIERIEM CPA P01330194 5029923500 2025-11-11 2024 2025-03-06 01:10:19Z DAN KLIDZEJS 131 HOSPITAL DRIVE SALEM KY 42078 28384055 0 X WWW.LHHS.ORG X 1964 KY TO PROVIDE PERSONALIZED, HIGH QUALITY HEALTHCARE, RESPONSIVE TO THE NEEDS OF THE COMMUNITY THROUGH CAREFUL STEWARDSHIP. 13 12 276 21 0 0 326114 465574 21836388 27763267 12811 39248 93153 115966 22268466 28384055 8419 9365 0 0 10158447 12376779 0 0 0 10686499 11904960 20853365 24291104 1415101 4092951 12688370 17719378 3161855 4099912 9526515 13619466 TO PROVIDE PERSONALIZED, HIGH QUALITY HEALTHCARE, RESPONSIVE TO THE NEEDS OF THE COMMUNITY THROUGH CAREFUL STEWARDSHIP. 0 0 21462046 9365 27874825 PROVIDE INPATIENT AND OUTPATIENT HEALTH SERVICES TO THREE WESTERN KENTUCKY COUNTIES. 21462046 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 1 0 0 0 1 42 0 1 276 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 12 1 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 KY X THE ORGANIZATION 2709882299 131 HOSPITAL DRIVE SALEM KY 42078 GHASSEN YAZIGI MD DIRECTOR/PHYSICIAN 40.00 0.00 X 513360 0 0 BARRY CHITTENDEN CHAIRMAN 1.00 0.00 X X 0 0 0 SUSAN ALEXANDER VICE-CHAIR (END 2024) 1.00 0.00 X X 0 0 0 JIM BELT VICE CHAIR 1.00 0.00 X X 0 0 0 TERRY TEITLOFF SECRETARY-TREASURER 0.50 2.00 X X 0 0 0 ANDY FOX DIRECTOR 0.50 0.00 X 0 0 0 WILLIAM GUYETTE MD DIRECTOR 0.50 0.00 X 0 0 0 DARYL DEGUIRE DIRECTOR 0.50 0.00 X 0 0 0 WILLIAM BARNES MD DIRECTOR 0.50 0.00 X 0 0 0 LARRY MCGREGOR DIRECTOR 0.50 0.00 X 0 0 0 STEVE WILLIAMS DIRECTOR 0.50 0.00 X 0 0 0 ALLAN WHITE MD DIRECTOR 0.50 0.00 X 0 0 0 JARED FLORENCE DIRECTOR 0.50 0.00 X 0 0 0 BRAD HOUSMAN MD DIRECTOR (BEG 2024) 0.50 0.00 X 0 0 0 SHANE WHITTINGTON CEO 40.00 1.00 X 0 0 0 DAN KLIDZEJS CFO 40.00 0.00 X 0 0 0 SAMANTHA SAMUELS PROVIDER 40.00 0.00 X 198902 0 28384 KRISTEE SHOULDERS PROVIDER 40.00 0.00 X 134414 0 8633 DEBRA PERRY NURSE 40.00 0.00 X 115530 0 0 TERESA WHITE PROVIDER 40.00 0.00 X 113327 0 20987 JESSICA SIGLER PROVIDER 40.00 0.00 X 113504 0 28955 1189037 0 86959 17 0 1 0 GHASSAN YAZIGI MD PSC 141 HOSPITAL DR SALEM KY 42078 MEDICAL SERVICES - PHYSICIAN 513360 KEYSTONE CONSTRUCTION LLC 4959 W JEFFERSON DAVIS HWY ELKTON KY 42220 CONSTRUCTION 491150 TRI-RIVERS HEALTH CARE PLLC 141 HOSPITAL DR SALEM KY 42078 MEDICAL SERVICES - PHYSICIAN 448836 METRIC ANESTHESIA CONSTULTANTS PLLC 4034 SAINT IVES CT LOUISVILLE KY 40207 MEDICAL SERVICES 428335 SANJAY BOSE MD 2601 KENTUCKY AVE 402 PADUCAH KY 42003 MEDICAL SERVICES - PHYSICIAN 187255 10 150000 10274 305300 465574 NET PATIENT SERVICE REVENUE 621999 27524072 27524072 340B PHARMACY REVENUE 621399 239195 239195 27763267 26748 26748 4408 0 4408 4408 4408 12500 0 12500 12500 12500 EMPLOYEE MEALS 900099 75056 75056 OCCUPATIONAL THERAPIST LEASE REVE 900099 28950 28950 TRANSCRIPTION SERVICES 900099 2024 2024 5528 5528 111558 28384055 27874825 0 43656 X 9365 9365 513360 472678 40682 9473841 8723074 750767 90021 82872 7149 1707283 1571692 135591 592274 545236 47038 37010 27926 9084 82896 62550 20346 5375697 4172969 1202728 40681 20700 19981 75399 38366 37033 540004 404087 135917 55913 28451 27462 22202 11297 10905 18344 9921 8423 346250 266128 80122 389442 307660 81782 MEDICAL SUPPLIES AND DR 3691969 3691098 871 REPAIRS & MAINTENANCE 622805 568760 54045 FOOD EXPENSE 169269 148548 20721 PROVIDER TAX 155274 155274 281805 143394 138411 24291104 21462046 2829058 0 2047719 2674201 2601947 3671084 3013900 2932020 64613 96344 556463 578310 233497 196887 17111247 11024159 3786631 6087088 383600 1483444 12688370 17719378 1420687 2285567 939913 634713 175000 105000 110842 565104 515413 509528 3161855 4099912 X 9526515 13619466 9526515 13619466 12688370 17719378 4092951 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1496 1496 0 PART II-B, LINE 1: LHHS IS A MEMBER OF KENTUCKY HOSPITAL ASSOCIATION. A PERCENTAGE OF MEMBERSHIP DUES PAID TO KHA IS ATTRIBUTABLE TO LOBBYING ACTIVITIES IN THE AMOUNT OF 13.7% FOR 2024. 352981 352981 3779490 3366086 413404 451039 295018 156021 7902408 7363055 539353 4625329 4625329 6087088 ROU ASSET - FINANCING LEASE 283906 ROU ASSET - OPERATING LEASE 213322 OTHER LONG TERM ASSETS 67308 ESTIMATED THIRD PARTY SETTLEMENTS 918908 1483444 ROU LIABILITY - FINANCE LEASE 296206 ROU LIABILITY - OPERATING LEASE 213322 509528 X PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND RECOGNIZE A TAX LIABILITY IF THE HOSPITAL HAS TAKEN AN UNCERTAIN TAX POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE HOSPITAL, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2024 AND 2023, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. 1 1 1 X 1 X 1 1 0 0 196969 196969 0.00810 4190354 7454890 0 0.00000 4387323 7454890 196969 0.00810 13036 13036 0.00050 270582 270582 0.01110 21 9365 9365 0.00040 21 292983 292983 0.01200 21 4680306 7454890 489952 0.02010 1 1349228 9852903 10228030 -375127 X 1 0 1 1 LIVINGSTON HOSPITAL & HEALTHCARE SERVICES INC 131 HOSPITAL DRIVE SALEM KY 42078 WWW.LHHS.ORG 600071 X X X X LIVINGSTON HOSPITAL & HEALTHCARE SERVICE 1 0 0 1 X X X X X X X X X 22 1 0 0 1 X WWW.LHHS.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT 1 22 1 WWW.LHHS.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT 0 1 X 200.000000000000 400.000000000000 X X 1 1 X X X X 1 X WWW.LHHS.ORG/FOR-YOU/PATIENTS-AND-VISITORS/PATIENTS/FINANCIAL-ASSISTANCE X WWW.LHHS.ORG/FOR-YOU/PATIENTS-AND-VISITORS/PATIENTS/FINANCIAL-ASSISTANCE X WWW.LHHS.ORG/FOR-YOU/PATIENTS-AND-VISITORS/PATIENTS/FINANCIAL-ASSISTANCE X X X X 1 0 X X X X 1 X 0 0 LIVINGSTON HOSPITAL & HEALTHCARE SERVICES, INC. PART V, SECTION B, LINE 5: THE COMMUNITY STEERING COMMITTEE PROVIDED A VITAL PART OF THE CHNA PROCESS. THESE INDIVIDUALS REPRESENT ORGANIZATIONS AND AGENCIES FROM THE SERVICE AREA AND IN PARTICULAR, THE INDIVIDUALS WHO WERE WILLING TO VOLUNTEER ENABLED THE HOSPITAL TO GET INPUT FROM POPULATIONS THAT WERE OFTEN NOT ENGAGED IN CONVERSATIONS ABOUT THEIR HEALTH NEEDS. COMMUNITY AND ECONOMIC DEVELOPMENT INITIATIVE OF KY (CEDIK) PROVIDED A LIST OF POTENTIAL AGENCIES AND ORGANIZATIONS THAT WOULD FACILITATE BROAD INPUT. THE ASSESSMENT PROCESS INCLUDED COLLECTING SECONDARY DATA RELATED TO THE HEALTH OF THE COMMUNITY. SOCIAL AND ECONOMIC DATA, AS WELL AS HEALTH OUTCOMES DATA, WAS COLLECTED FROM SECONDARY SOURCES TO HELP PROVIDE CONTEXT FOR THE COMMUNITY. ADDITIONALLY, CEDIK COMPILED HOSPITAL UTILIZATION DATA TO BETTER UNDERSTAND WHO WAS USING THE FACILITY AND FOR WHAT SERVICES. FINALLY, WITH THE ASSISTANCE OF THE COMMUNITY STEERING COMMITTEE, INPUT FROM THE COMMUNITY WAS COLLECTED THROUGH FOCUS GROUP DISCUSSIONS AND SURVEYS. LIVINGSTON HOSPITAL & HEALTHCARE SERVICES, INC. PART V, SECTION B, LINE 11: THE HOSPITAL ADDRESSED NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA THROUGH ADOPTION OF AN IMPLEMENTATION STRATEGY THAT ADDRESSES EACH OF THE COMMUNITY HEALTH NEEDS IDENTIFIED THROUGH THE CHNA, EXECUTION OF THE IMPLEMENTATION STRATEGY, ADOPTION OF A BUDGET FOR PROVISION OF SERVICES THAT ADDRESS THE NEEDS IDENTIFIED IN THE CHNA, PRIORITIZATION OF HEALTH NEEDS IN ITS COMMUNITY AND PRIORITIZATION OF SERVICES THAT THE HOSPITAL FACILITY WILL UNDERTAKE TO MEET HEALTH NEEDS IN ITS COMMUNITY. 5 1 - GRAND LAKES CLINIC 1860 JH OBRYAN AVE GRAND RIVERS KY 42045 RURAL HEALTH CLINIC 2 - EDDYVILLE FAMILY MEDICAL 209 W MAIN STRET EDDYVILLE KY 42038 RURAL HEALTH CLINIC 3 - LIVINGSTON CARE CLINIC 117 EAST MAIN STREET SALEM KY 42078 RURAL HEALTH CLINIC 4 - NEW BEGINNINGS BEHAVIORAL HEALTH 129 W MAIN STREET SALEM KY 42078 RURAL HEALTH CLINIC 5 - LIVINGSTON HOSPITAL FAMILY CLINIC 909 S MAIN STREET ST MARION KY 42064 CLINIC PART I, LINE 7: THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED VARY ACCORDING TO THE INFORMATION REQUESTED AND THE MOST ACCURATE MEANS OF GATHERING THE REQUIRED INFORMATION. THE IRS PROVIDED WORKSHEET NUMBER 2 WHICH WAS USED TO CALCULATE A COST TO CHARGE RATIO USING INFORMATION FROM THE ORGANIZATION'S GENERAL LEDGER AND COST REPORTS. THAT RATIO WAS THEN USED IN CONJUNCTION WITH IRS WORKSHEET NUMBER 1 TO CALCULATE THE COST OF FINANCIAL ASSISTANCE PROVIDED AND WORKSHEET NUMBER 3 WAS USED TO CALCULATE UNREIMBURSED MEDICAID AMOUNTS. THE ORGANIZATION'S COST ACCOUNTING PROGRAM WAS UTILIZED FOR CALCULATING PORTIONS OF THE SUBSIDIZED HEALTH SERVICES. THE ORGANIZATION'S COST ACCOUNTING PROGRAM ENCOMPASSES ALL PATIENT TYPES, SERVICES AND PAYORS. THE COST ASSOCIATED WITH A SERVICE ARE REVIEWED AND UPDATED ANNUALLY TO PROVIDE THE MOST ACCURATE COST POSSIBLE. BOTH DIRECT AND INDIRECT COSTS ARE UTILIZED IN CALCULATING COST. PART I, LINE 7G: ACTUAL COSTS WERE USED TO CALCULATE THE NET BENEFIT FOR SUBSIDIZED HEALTH SERVICES ON LINE 7G. SCHEDULE H, PART I, LINE 7 EFFECTIVE JULY 1, 2019, THE HOSPITAL HAS BEEN PARTICIPATING IN THE MEDICAID HOSPITAL RATE IMPROVEMENT PROGRAM ("HRIP"). THIS PROGRAM WAS DESIGNED TO PROVIDE SUPPLEMENTAL MEDICAID PAYMENTS TO CERTAIN KENTUCKY HOSPITALS TO COVER THE GAP BETWEEN REGULAR INPATIENT MEDICAID PAYMENTS AND MEDICARE ALLOWABLE COSTS. EFFECTIVE JULY 1, 2020, THE PROGRAM WAS MODIFIED TO PROVIDE SUPPLEMENTAL MEDICAID PAYMENTS TO CERTAIN KENTUCKY HOSPITALS TO COVER THE GAP BETWEEN INPATIENT MEDICAID PAYMENTS AND THE AVERAGE COMMERCIAL PAYMENT RATE. THE AMOUNT HOSPITALS RECEIVE IS DETERMINED ANNUALLY PRIOR TO EACH STATE FISCAL YEAR. THE PAYMENTS ARE MADE EACH QUARTER, AND THEY ARE BASED ON PAID CLAIMS, WITH THE STATE MATCHING FUNDS COMING FROM A NEW ASSESSMENT ON HOSPITALS EVERY QUARTER. PART III, LINE 2: THE HOSPITAL HAS AN ESTABLISHED PROCESS TO DETERMINE THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS THAT RELIES ON A NUMBER OF ANALYTICAL TOOLS AND BENCHMARKS TO ARRIVE AT A REASONABLE ALLOWANCE. NO SINGLE STATISTIC OR MEASUREMENT DETERMINES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. SOME OF THE ANALYTICAL TOOLS THAT THE HOSPITAL UTILIZES INCLUDE, BUT ARE NOT LIMITED TO, HISTORICAL CASH COLLECTION EXPERIENCE BY PAYOR, REVENUE TRENDS BY PAYOR CLASSIFICATION AND AGED ACCOUNTS FROM DATE OF SERVICE BY PAYOR. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE HOSPITAL'S POLICIES. PART III, LINE 3: THE HOSPITAL DOES NOT HAVE BAD DEBT EXPENSES RELATED TO THE PATIENTS ELIGIBLE UNDER THE HOSPITAL'S CHARITY CARE POLICY. PART III, LINE 4: SEE PAGES 9 AND 10 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE MEDICARE SHORTFALL/SURPLUS IS CALCULATED BASED ON NUMBERS FROM THE FILED 2024 COST REPORT. ANY SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. PART III, LINE 9B: OUTSTANDING ACCOUNTS WILL BE COLLECTED IN-HOUSE, IF AT ALL POSSIBLE, BEFORE BEING REFERRED TO AN OUTSIDE COLLECTION AGENCY. IF A BALANCE REMAINS UNPAID AND NO PAYMENT EFFORTS ARE MADE, ACCOUNTS WILL BE REFERRED TO CONTRACTED COLLECTION AGENCIES AFTER APPROXIMATELY 90 DAYS OF THE BALANCE BECOMING THE PATIENT'S RESPONSIBILITY. PRIVATE PAY ACCOUNTS WILL BE ADDRESSED PRIOR TO SERVICE BEING RENDERED. THE PATIENT WILL APPLY FOR THE DISPROPORTIONATE SHARE HOSPITAL PROGRAM (DSH). IN THE EVENT THE PATIENT IS ELIGIBLE FOR DSH, THE DSH COORDINATOR WILL FOLLOW UP WITH THE PATIENT. IN THE EVENT THE PATIENT IS NOT ELIGIBLE FOR THE DSH PROGRAM, THE ACCOUNT WILL BECOME PRIVATE PAY. THE DOCTOR WILL DETERMINE WHETHER THE PROCEDURE IS MEDICALLY NECESSARY OR ELECTIVE. IN THE EVENT THE PROCEDURE IS DEEMED MEDICALLY NECESSARY, THE PATIENT WILL BE ASKED TO MAKE A DEPOSIT AND SIGN A FINANCIAL AGREEMENT. IF A PROCEDURE IS DETERMINED TO BE ELECTIVE, THE PATIENT WILL BE ASKED TO PAY 75% OF THE AMOUNT DUE PRIOR TO SERVICES BEING RENDERED. IN THE EVENT A PRIVATE PAY PATIENT IS PRESENT FOR SERVICE WHILE THE REGISTRATION OFFICE IS CLOSED, A DSH COORDINATOR WILL CONTACT THE PATIENT THE FOLLOWING BUSINESS DAY. IN THE EVENT THE DSH COORDINATOR IS UNABLE TO REACH THE PATIENT BY PHONE, A DSH APPLICATION WILL BE MAILED TO THE PATIENT. AFTER 10 DAYS AND THE APPLICATION HAS NOT BEEN RETURNED, THE DSH COORDINATOR WILL CONTACT THE PATIENT BY PHONE. IN THE EVENT THE PATIENT IS UNABLE TO BE REACHED BY PHONE, THE ACCOUNT WILL BE REFERRED TO THE CONTRACTED COLLECTION AGENCIES. IN THE EVENT A PATIENT IS COVERED BY INSURANCE AND A PORTION OF THE BILL IS NOT COVERED, LEAVING A BALANCE DUE FROM THE PATIENT, MONTHLY STATEMENTS WILL BE SENT OUT REQUESTING PAYMENT. PART VI, LINE 2: THE HOSPITAL ASSESSES THE NEEDS OF THE COMMUNITIES IT SERVES BY PROVIDING FREE HEALTH SCREENINGS AT LOCAL FESTIVALS, SENIOR CITIZEN CENTERS, CHURCH FUNCTIONS AND SCHOOL FUNCTIONS. AT HEALTH FAIRS, SCREENINGS ARE OFFERED FOR CHOLESTEROL, BLOOD GLUCOSE, BLOOD PRESSURE, PULSE OXYGEN, HEART RATE AND BODY CHEMISTRY ANALYSIS (BODY MASS INDEX AND % BODY FAT). THE HOSPITALWORKS CLOSELY WITH OTHER AGENCIES IN THE COUNTIES IT SERVES AS TO BETTER SERVE THE COMMUNITY. PART VI, LINE 3: THE HOSPITAL IS COMMITTED TO PROVIDING HEALTH CARE TO EVERYONE IN NEED, REGARDLESS OF THEIR ABILITY TO PAY. BILLING STATEMENTS INCLUDE INFORMATION ABOUT HOW TO CONTACT FINANCIAL COUNSELORS AND ARRANGE PAYMENT PLANS. THE HOSPITAL OFFERS CHARITY CARE TO UNINSURED PATIENTS WHO QUALIFY FOR THE PROGRAM. FINANCIAL COUNSELORS CONTACT PATIENTS ON THE FRONT END TO RECOGNIZE WHO NEEDS ASSISTANCE AND TO EDUCATE AND HELP THEM APPLY FOR THE DISPROPORTIONATE SHARE HOSPITAL (DSH) PROGRAM, ALONG WITH OTHER FEDERAL PROGRAMS IN WHICH THEY MAY BE ELIGIBLE. PART VI, LINE 4: LIVINGSTON COUNTY, LOCATED IN WESTERN KENTUCKY, HAS A POPULATION OF APPROXIMATELY 8,815 PEOPLE ACCORDING TO THE 2024 CENSUS. THE POPULATION IS COMPRISED OF 50.2% FEMALE AND 49.8% MALE AND IS 96.5% CAUCASIAN. THE MEDIAN HOUSEHOLD INCOME IS APPROXIMATELY $59,713. ACCORDING TO THE 2024 CENSUS, APPROXIMATELY 18.9% OF INDIVIDUALS ARE LIVING IN POVERTY. 7.4% OF PATIENTS UNDER 65 ARE UNINSURED. THE HOSPITAL PROVIDES CARE TO INPATIENTS, OUTPATIENTS, OBSERVATION PATIENTS AND SWING BED PATIENTS FROM THE SURROUNDING COUNTIES. SEVERAL OF THE SURROUNDING COUNTIES HAVE HOSPITALS, HOWEVER, LIVINGSTON HOSPITAL IS THE CLOSEST CRITICAL ACCESS HOSPITAL FOR THE COMMUNITY. PART VI, LINE 5: LHHS SPONSORS HEALTH FAIRS THROUGHOUT THE YEAR IN LIVINGSTON, LYON AND CRITTENDEN COUNTIES. AT THE HEALTH FAIRS, LHHS OFFERED SCREENINGS FOR CHOLESTEROL, BLOOD GLUCOSE, BLOOD PRESSURE, PULSE OXYGEN, HEART RATE, AND BLOOD CHEMISTRY ANALYSIS. LHHS PARTICIPATES IN MANY ACTIVITIES WITH THE AREA SCHOOL SYSTEMS SUCH AS REALITY STORES, WELLNESS DAY, CAREER FAIR, FARM FIELD DAY, FITNESS AND NUTRITION CLUB, FREE SPORTS PHYSICALS AND CARDIAC SCREENINGS. PART VI, LINE 6: OUR PARTNERSHIP WITH DEACONESS WILL HELP US BRING NEW PHYSICIANS, SPECIALISTS, AND SERVICES TO THE AREA, WHILE KEEPING A LOCAL FOCUS ON QUALITY HEALTHCARE IN LIVINGSTON COUNTY. 0 DONATIONS AND OTHER SUPPORT 21 9365 X X X 0 0 0 0 0 0 0 0 0 GHASSEN YAZIGI MD DIRECTOR/PHYSICIAN 513360 0 0 0 0 0 0 0 0 0 513360 0 0 0 SAMANTHA SAMUELS PROVIDER 198902 0 0 0 0 0 325 0 28059 0 227286 0 0 0 A SHELBY COUNTY KENTUCKY 610610257 000000000 2004-09-01 1000000 WORKING CAPITAL 0 0 0 A 895000 1000000 1000000 2008 0 0 1 1 A 0 0 1 0 1 0 0 0 1 A 1 SCH K ADDENDUM: THE HOSPITAL HAS A LEASE WITH KACO LEASING TRUST AND FILES SCHEDULE K TO PROVIDE COMPLETE REPORTING RELATING TO THIS LEASE. AS A RESULT, SOME QUESTIONS APPLICABLE TO BOND COMPLIANCE DO NOT APPLY. UNDER THE TERMS OF THE LEASING TRUST, THE HOSPITAL PAYS DOWN PRINCIPAL EACH YEAR. THE AMOUNT OF PRINCIPAL PAID IN 2024 WAS $70,000. THE TOTAL PRINCIPAL PAID AS OF YEAR-END 2024 WAS $895,000. WILLIAM BARNES MD PARTNER OF TRI-RIVERS HEALTHCARE, PLLC 411516 LHHS PAID TRI-RIVERS HEALTHCARE, PLLC FOR SURGERY CALL FEES AND MID-LEVEL SUPERVISION IN THE ER. 0 FORM 990, PART VI, SECTION A, LINE 2 DR. YAZIGI AND DR. BARNES HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 3 AS OF THE EFFECTIVE DATE OF THE AMENDED BY-LAWS ON JANUARY 1, 2022, THE BOARD HAS ARRANGED FOR THE PROVISION BY DEACONESS OF A CEO AND A CFO PURSUANT TO A MANAGEMENT SERVICES AGREEMENT BETWEEN THE CORPORATION AND DEACONESS. DEACONESS HEALTH KENTUCKY, INC. ("DHKY"), AN AFFILIATE OF DEACONESS HEALTH SYSTEM, INC. ("DEACONESS") HAS SIGNIFICANT EXPERIENCE IN THE MANAGEMENT AND OPERATION OF HOSPITAL FACILITIES. FORM 990, PART VI, SECTION B, LINE 11B MANAGEMENT WILL PROVIDE EITHER A PAPER OR ELECTRONIC COPY OF FORM 990 TO THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS AND DIRECTORS ARE REQUIRED TO ANNUALLY DISCLOSE CONFLICTS OF INTERESTS. THESE CONFLICTS ARE REVIEWED ANNUALLY BY THE HOSPITAL'S ATTORNEY. BOARD MEMBERS ARE REQUIRED TO RECUSE THEMSELVES FROM THE DISCUSSION AND VOTE WHEN/IF A CONFLICT ARISES. FORM 990, PART VI, SECTION B, LINE 15 LINE 15A: THE CEO IS COMPENSATED BY AFFILIATE DEACONESS HEALTH KENTUCKY, INC. THE CEO'S COMPENSATION IS DETERMINED BY THE BOARD OF DIRECTORS BASED ON PRIOR EXPERIENCE WITH MANAGEMENT BOARDS. COMPENSATION IS REVIEWED, APPROVED, AND DOCUMENTED BY INDEPENDENT PERSONS PRIOR TO SETTING COMPENSATION. LINE 15B: THE CFO IS ALSO COMPENSATED BY AFFILIATE DEACONESS HEALTH KENTUCKY, INC., WHICH IS DETERMINED BY THE BOARD OF DIRECTORS BASED ON PRIOR EXPERIENCE WITH MANAGEMENT BOARDS. COMPENSATION FOR THE CFO AND ALL OTHER OFFICERS OF LHHS IS REVIEWED, APPROVED AND DOCUMENTED ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST AND SUBJECT TO BOARD AND MANAGEMENT DISCRETION. FORM 990, PART IX, LINE 11G PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 1,961,027. MANAGEMENT AND GENERAL EXPENSES 483,254. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,444,281. PROFESSIONAL FEES : PROGRAM SERVICE EXPENSES 2,211,942. MANAGEMENT AND GENERAL EXPENSES 719,474. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,931,416. LIVINGSTON HOSPITAL FOUNDATION INC 131 HOSPITAL DRIVE SALEM KY 42078 270556814 SUPPORT OF HOSPITAL KY 501(C)(3) LINE 12A, I LIVINGSTON HOSPITAL & HEALTHCARE SERVICES INC 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 LIVINGSTON HOSPITAL FOUNDATION INC C 150000 CASH