2026-04-01T14:48:51-05:00 2025-06-30 351178661 BLUE & CO LLC 2650 EASTPOINT PKWY SUITE 300 LOUISVILLE KY 40223 990 2024-07-01 610624096 CUMBERLAND COUNTY HOSPITAL ASSOCIATION INC CUMB 2708642511 PO BOX 280 BURKESVILLE KY 42717 LORI BETH CASH CFO 2708642511 2026-04-01 1 0 EMILIE M KNIERIEM CPA P01330194 5029923500 2026-04-01 2024 2025-03-06 01:10:19Z LORI BETH CASH PO BOX 280 BURKESVILLE KY 42717 22694125 0 X WWW.CCHOSPITAL.ORG X 1964 KY CUMBERLAND COUNTY HOSPITAL SEEKS TO BECOME THE NETWORK LEADER IN PROVIDING, COORDINATING, AND CONTRACTING THE FULL CONTINUUM OF HEALTH CARE SERVICES REQUIRED BY RESIDENTS. 9 6 260 6 66000 48834 63972 20804 21626458 21467564 494759 693267 574743 512490 22759932 22694125 0 0 0 0 13324624 13681677 0 0 0 7090267 7374300 20414891 21055977 2345041 1638148 29615684 31689083 9143060 9578311 20472624 22110772 CUMBERLAND COUNTY HOSPITAL SEEKS TO BECOME THE NETWORK LEADER IN PROVIDING, COORDINATING, AND CONTRACTING THE FULL CONTINUUM OF HEALTH CARE SERVICES REQUIRED BY RESIDENTS OF CUMBERLAND COUNTY. 0 0 16281655 21899442 CUMBERLAND COUNTY HOSPITAL, IN PARTNERSHIP WITH ITS MEDICAL STAFF, EMPLOYEES, AND OTHER PROVIDERS, STRIVES TO BE RECOGNIZED FOR HIGH-QUALITY, COST-EFFECTIVE CARE RESULTING IN COMMUNITY PRIDE, CONFIDENCE, AND SUPPORT. THE HOSPITAL ACKNOWLEDGES THE PARTNERSHIPS REQUIRED WITH ITS MEDICAL STAFF, ITS EMPLOYEES, AND OTHER PROVIDERS TO ACHIEVE THIS VISION. THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES TO PATIENTS IN CUMBERLAND COUNTY, KY AND SURROUNDING COUNTIES. THE HOSPITAL PROVIDES APPROXIMATELY $50,347 IN CHARITY CARE DURING THE YEAR ENDED JUNE 30, 2025. 16281655 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 55 0 1 260 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 9 6 1 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 KY X CUMBERLAND COUNTY HOSPTIAL ORGANIZATION 2708642511 PO BOX 280 BURKESVILLE KY 42717 X DR ROBERT FLOWERS JR DO PHYSICIAN/CHIEF OF STAFF 40.00 X 586723 0 35904 RICHARD NEIKIRK SR VICE CHAIRMAN 40.00 X X 128876 0 20818 HARVEY GRAVES BOARD MEMBER/DIRECTOR MAINTENANCE 40.00 X 126351 0 15433 TODD MORGAN CHAIRMAN 1.00 X X 0 0 0 VICKIE WELLS SECRETARY/TREASURER 1.00 X X 0 0 0 DOUGLAS BUTLER BOARD MEMBER 1.00 X 0 0 0 STEVE D HURT BOARD MEMBER 1.00 X 0 0 0 CHUCK PRICE BOARD MEMBER 1.00 X 0 0 0 JEFFREY VIBBERT BOARD MEMBER 1.00 X 0 0 0 RICHARD NEIKIRK II CEO 40.00 X X 167056 0 13345 RANDALL T DAVIDSON COO 40.00 X 122949 0 11623 SUSAN FLOWERS CNO 40.00 X 132085 0 9182 LORI BETH CASH CFO 40.00 X 146066 0 8297 DR ROBERT FLOWERS SR PHYSICIAN 40.00 X 735553 0 18248 DR LAUREN DYER-HURT PHYSICIAN 40.00 X 279671 0 16325 DR CHRISTIAN KONSAVAGE PHYSICIAN 40.00 X 245685 0 857 VICTORIA KINGREY DIRECTOR BFT/APRN 40.00 X 189047 0 14411 MEGAN SELLS PHARMACIST 40.00 X 167248 0 21369 DR SAMUEL RICE MD FORMER CHIEF OF STAFF 40.00 X 443966 0 15795 RICHIE CAPPS FORMER CFO 40.00 X 161150 0 13820 3632426 0 215427 26 1 1 0 INFINITY TELERADIOLOGY 17365 LOOKOUT DRIVE CHAGRIN FALLS OH 44023 INTERPRETIVE SERVICES 213256 340B TOGETHER PO BOX 641 FOREST MS 39074 340B MANAGEMENT SERVICES 211064 INSPIRE MEDICAL INC 11501 PARK ROAD 23019 LOUISVILLE KY 40223 ER PHYSICIAN COVERAGE 182891 BLUE & CO LLC 2650 EASTPOINT PARKWAY LOUISVILLE KY 40223 PROFESSIONAL SERVICES 152400 TRUBRIDGE INC 54 ST EMANUEL STREET MOBILE AL 36602 SOFTWARE SERVICES 117065 5 10000 10804 20804 NET PATIENT SERVICE REVENUE 621999 21467564 21467564 21467564 693267 693267 78715 0 78715 78715 66000 12715 AMBULANCE SERVICE 621910 310000 310000 CAFETERIA & VENDING 722310 42839 40942 1897 REBATES 900099 22959 22959 57977 57977 433775 22694125 21899442 66000 707879 X 1008302 816348 191954 602735 487990 114745 10190777 8250719 1940058 292967 237194 55773 743111 601642 141469 843785 683150 160635 36504 23088 13416 158471 158471 2225097 1407314 817783 10064 6331 3733 374405 235544 138861 355857 223876 131981 30295 19059 11236 250573 250573 933131 674451 258680 370911 233346 137565 MEDICAL SUPPLIES 1763856 1763856 REPAIRS & MAINTENANCE 458287 288316 169971 PROVIDER TAX 198108 198108 DUES & SUBSCRIPTION 67881 42705 25176 140860 88618 52242 21055977 16281655 4774322 0 1000 505020 15778895 19913951 2224648 2311402 269913 208218 508627 585175 130867 128475 21952342 16163801 6529929 5788541 4171805 2248301 29615684 31689083 1972801 2560552 7170259 7017759 9143060 9578311 X 20472624 22110772 20472624 22110772 29615684 31689083 1638148 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 1820 1820 0 PART II-B, LINE 1: A PERCENTAGE OF DUES PAID TO THE KENTUCKY HOSPITAL ASSOCIATION ARE ATTRIBUTABLE TO LOBBYING ACTIVITIES. 547269 547269 10825917 7917617 2908300 561631 490822 70809 10017525 7755362 2262163 5788541 ASSETS WHOSE USE IS LIMITED 1206571 THIRD PARTY SETTLEMENT 1041730 2248301 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 JUNE 30, 2025 AND 2024, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING CONSOLIDATED 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 X 1 X 1 X 150.000000000000 1 1 0 0 54541 54541 0.00260 4127181 6544596 0 0.00000 4181722 6544596 54541 0.00260 26400 26400 0.00130 3 1953771 1663069 290702 0.01380 3 1980171 1663069 317102 0.01510 3 6161893 8207665 371643 0.01770 1 867697 12314 6024600 7394386 -1369786 X 1 0 1 1 CUMBERLAND COUNTY HOSPITAL 299 GLASGOW ROAD BURKESVILLE KY 42717 600068 X X X CUMBERLAND COUNTY HOSPITAL 1 0 0 1 X X X X X X X X X 22 1 0 0 1 X WWW.CCHOSPITAL.ORG X 1 22 1 WWW.CCHOSPITAL.ORG 0 1 X 150.000000000000 150.000000000000 X X 1 1 X X X 1 X HTTP://WWW.CCHOSPITAL.ORG/FINANCIALASSISTANCE.HTML X HTTP://WWW.CCHOSPITAL.ORG/FINANCIALASSISTANCE.HTML X HTTP://WWW.CCHOSPITAL.ORG/FINANCIALASSISTANCE.HTML X X X X 1 X 0 X X X X 1 X 0 0 CUMBERLAND COUNTY HOSPITAL PART V, SECTION B, LINE 5: THE PRIMARY DATA WAS COLLECTED, ANALYZED, AND PRESENTED WITH THE ASSISTANCE OF BLUE. TWO PRIMARY DATA COLLECTION METHODS WERE USED: 1) ONLINE SURVEYS AND 2) PERSONAL INTERVIEWS.A SURVEY WAS DEVELOPED BY CUMBERLAND COUNTY HOSPITAL AND USED TO SOLICIT PERCEPTIONS, INSIGHTS, AND GENERAL UNDERSTANDING FROM COMMUNITY MEMBERS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH. THESE INDIVIDUALS ALSO REPRESENTED THE INTERESTS OF THE MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS OF THE COMMUNITY SERVED. THE SURVEY WAS COMPRISED OF TWENTY-NINE QUESTIONS IN TOTAL. COMMUNITY LEADERS WERE ASKED THE FOLLOWING KEY QUESTIONS: TOP THREE MOST SIGNIFICANT HEALTH NEEDS IN THE COMMUNITY, PERCEPTION OF THE AVAILABILITY OF SERVICES, HEALTH STATUS, PROVIDER COORDINATION, AND BARRIERS. ADDITIONALLY, THE PARTICIPANTS WERE ALLOWED TO WRITE IN ISSUES NOT LISTED. THE SURVEY RESULTS CAN BE FOUND IN THE COMMUNITY SURVEY RESULTS SECTION OF THE REPORT. PERSONAL INTERVIEWS WERE CONDUCTED BY CUMBERLAND, WITH A TOTAL OF 11 PARTICIPANTS DURING APRIL OF 2022, WITH EACH SESSION LASTING APPROXIMATELY 30 MINUTES. THESE SESSIONS WERE CONDUCTED WITH COMMUNITY MEMBERS SERVED BY CUMBERLAND COUNTY HOSPITAL, INCLUDING PUBLIC SERVICE LEADERS, HEALTH EXPERTS, PUBLIC OFFICIALS, PHYSICIANS, HOSPITAL EMPLOYEES, AND OTHER HEALTH PROFESSIONALS AND PROVIDERS, INCLUDING THOSE ASSOCIATED WITH CUMBERLAND COUNTY HOSPITAL. THE PRIMARY OBJECTIVE WAS TO SOLICIT PERCEPTIONS REGARDING HEALTH NEEDS AND SERVICES OFFERED IN THE COMMUNITY, ALONG WITH ANY OPPORTUNITIES OR BARRIERS TO SATISFYING REQUIREMENTS. CUMBERLAND COUNTY HOSPITAL PART V, SECTION B, LINE 11: ON BEHALF OF CUMBERLAND COUNTY HOSPITAL, A COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA") WAS CONDUCTED IN 2022 PRIMARILY TO IDENTIFY THE MAJOR HEALTH NEEDS, BOTH MET AND UNMET, WITHIN THE SURROUNDING COMMUNITY. THE COMMUNITY'S GEOGRAPHIC AREA IS COMPRISED PRIMARILY OF CUMBERLAND COUNTY WITH A POPULATION OF 6,697 ACCORDING TO THE 2019 CENSUS. THE PRIMARY OBJECTIVES OF THE CHNA WERE TO: 1) IDENTIFY MAJOR HEALTH NEEDS WITHIN THE COMMUNITY TO IMPROVE THE HEALTH OF THE AREA'S RESIDENTS AND FACILITATE COLLABORATION AMONG LOCAL HEALTHCARE PROVIDERS, AND 2) SATISFY THE FEDERAL GUIDELINES WITHIN THE PATIENT PROTECTION AND AFFORDABLE CARE ACT ("PPACA") OF 2010. DATA FOR THIS CHNA WAS COLLECTED FROM PRIMARY AND SECONDARY SOURCES TO IDENTIFY KEY FINDINGS AND GAPS THAT MAY EXIST BETWEEN HEALTH NEEDS AND SERVICES PROVIDED WITHIN THE COMMUNITY. THE METHOD OF COLLECTION FOR PRIMARY DATA WERE PERSONAL INTERVIEWS AND SURVEYS. SEVERAL SECONDARY DATA SOURCES WERE REVIEWED AND ANALYZED TO IDENTIFY KEY FINDINGS WITH STRATEGIC IMPLICATIONS AND FOR BENCHMARKING THE HOSPITAL'S SERVICE AREA. FINALLY, IT IS IMPORTANT TO NOTE THAT OUR DATA COLLECTION DID NOT INCLUDE A STATISTICALLY REPRESENTATIVE SAMPLE OF THE COMMUNITY, IN THAT MEMBERS OF DISADVANTAGED POPULATIONS WERE LESS LIKELY TO PARTICIPATE VIA A WEB-BASED SURVEY. THESE INDIVIDUALS MAY INCLUDE IMMIGRANTS, THE HOMELESS, AS WELL AS INDIVIDUALS WITH LOW EDUCATION AND INCOME LEVELS. HIGHLIGHTED, SUBSEQUENTLY, ARE IMPORTANT FINDINGS IDENTIFIED THROUGH THE DATA COLLECTION, ANALYSIS, AND ASSESSMENT PROCESS:- ACCESS TO CARE- DRUG ABUSE- HEALTH OUTCOMES AND INACTIVITY/OBESITY- TEEN BIRTHS- MENTAL HEALTHCUMBERLAND COUNTY HAS IDENTIFIED THE ABOVE NEEDS FOR ITS COMMUNITY AND PRIORITIZED THEM BASED ON THE ORDER ABOVE. CUMBERLAND COUNTY HOSPITAL PART V, SECTION B, LINE 13B: DETERMINING FREE CARE: STATE GUIDELINES ARE FOLLOWED FOR ELIGIBILITY REQUIREMENTS AS SET FORTH BY DMS FOR DISPROPORTIONATE SHARE HOSPITAL PROGRAMS FOR THE CURRENT YEAR. UPON COMPLETION OF THE APPLICATION, IT CAN BE DETERMINED WHETHER THE PATIENT IS ELIGIBLE FOR CHARITY. IF THE PATIENT IS ELIGIBLE 100% WILL BE ADJUSTED. THE INCOME LIMITS ARE FOR A HOUSEHOLD SIZE OF ONE, AN ANNUAL INCOME OF $13,520 OR LOWER QUALIFIES. FOR EACH ADDITIONAL PERSON IN THE HOUSEHOLD THE INCOME LIMIT IS INCREASED $4,680.DETERMINING DISCOUNTED CARE: ALL PATIENTS WITH A PRIVATE PAY BALANCE OF ANY FORM (DEDUCTIBLE, ALL CHARGES ETC.) QUALIFY FOR A 25% DISCOUNT IMMEDIATELY WITH A PROMPT PAYMENT OR PROMPT REPAYMENT PLAN. PART V, SECTION B, LINE 11 PRIORITY 1 - ACCESS TO CAREGOAL: INCREASE FLU VACCINE RATESSTRATEGIES: - EXPAND THE EDUCATION ON FLU VACCINES IN THE COMMUNITY - ENSURE THAT THE AVAILABILITY OF THE FLU VACCINES IS COMMUNICATED WELL TO THE COMMUNITY AND RESEARCH ALL MEDIA AVENUES OF COMMUNICATION - UPDATE FLU VACCINATION INFORMATION AS A HEALTH LITERACY INTERVENTION THAT USE WRITTEN AND PRINT-BASED MATERIALS DESIGNED TO BE EASY TO READ AND UNDERSTAND. PRIORITY 2 - LOW ACCESS TO EXERCISE OPPORTUNITIES GOAL: EDUCATE THE COMMUNITY ON AVAILABILITY STRATEGIES: - EDUCATE AND INFORM PATIENTS OF LOCAL PLACES, FORMS AND AVAILABILITY TO EXERCISEPRIORITY 3 - ACCESS TO CARE: GOAL: EDUCATE PATIENTS ON ACCESS TO CARESTRATEGIES: - HOST OUTPATIENT CLINICS WITH PHYSICIANS FROM OTHER COUNTIES TO COME TO SEE PATIENTS LOCALLY INSTEAD OF THE PATIENT HAVING TO TRAVEL- EDUCATE PATIENTS ON LOCAL TRANSPORTATION AVAILABLE TO REACH THE CARE LOCATIONS PRIORITY 4 - DRUG AND ALCOHOL ABUSEGOAL: INCREASE AWARENESS AND TREATMENT OPPORTUNITIES STRATEGIES: - CREATE RESOURCES AND EVENTS THAT FOCUS ON EDUCATION AND SUPPORT- SHARE INFORMATION AND TREATMENT OPPORTUNITIES FROM OUTSIDE SOURCES - PARTNER WITH LOCAL PHYSICIANS, COMMUNITY MEMBERS, AND TREATMENT PROGRAMS TO INCREASE ACCESS TO MEDICATION-ASSISTED TREATMENT (MAT) FOR OPIOID USE DISORDERPRIORITY 5 - TEEN BIRTHS GOAL: AWARENESS OF NATIONAL TREND ON TEEN BIRTHS STRATEGIES: - CREATE AWARENESS AND RESOURCES INFORMING THE COMMUNITY OF THE HIGH TREND OF LOCAL TEEN BIRTHS.- INCREASE EDUCATION AT YOUNGER AGE ON TEEN BIRTHS - PARTNER WITH LOCAL TEEN PREGNANCY PREVENTION (TPP) PROGRAM 2 1 - BF TAYLOR CLINIC 299A GLASGOW ROAD BURKESVILLE KY 42717 RURAL HEALTH CLINIC 2 - FLOWERS RURAL HEALTH CLINIC 333 KEEN STREET BURKESVILLE KY 42717 RURAL HEALTH CLINIC PART I, LINE 3C: DETERMINE FREE CARE: STATE GUIDELINES ARE FOLLOWED FOR ELIGIBILITY REQUIREMENTS AS SET FORTH BY DMS FOR DISPROPORTIONATE SHARE HOSPITAL PROGRAMS FOR THE CURRENT YEAR. UPON COMPLETION OF THE APPLICATION, IT CAN BE DETERMINED WHETHER THE PATIENT IS ELIGIBLE FOR CHARITY. IF THE PATIENT IS ELIGIBLE 100% WILL BE ADJUSTED. THE INCOME LIMITS ARE FOR A HOUSEHOLD SIZE OF ONE AND ANNUAL INCOME OF $13,520 OR LOWER QUALIFIES. FOR EACH ADDITIONAL PERSON IN THE HOUSEHOLD THE INCOME LIMIT IS INCREASED $4,680. DETERMINIE DISCOUNTED CARE: ALL PATIENTS WITH A PRIVATE PAY BALANCE OF ANY FORM (DEDUCTIBLE, ALL CHARGES ETC.) QUALIFY FOR A 25% DISCOUNT IMMEDIATELY WITH A PROMPT PAYMENT OR PROMPT REPAYMENT PLAN. 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 COST REPORT WORKSHEET S-10 COST-TO-CHARGE RATIO WAS USED. 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. HEALTH IMPROVEMENT AND COMMUNITY BENEFIT PROGRAMS AND SUBSIDIZED SERVICES ARE STATED AT ACTUAL COST. THE COST OF THESE ITEMS ARE TRACKED THROUGHOUT THE GENERAL LEDGER PROCESS. PART III, LINE 2: THE BAD DEBT EXPENSE CONTAINS THE TRUE EXPENSES WRITTEN OFF DURING THE YEAR DUE TO NON PAYMENT AFTER ALL COLLECTION ATTEMPTS HAVE BEEN PERFORMED. THE EXPENSE ALSO CONTAINS AN ALLOWANCE THAT HAS A PERCENTAGE THAT IS AGREED UPON WITH BLUE AND COMPANY APPLIED TO THE CURRENT A/R AND THEN THAT ALLOWANCE IS EXPENSED. PART III, LINE 3: THE COLLECTIONS DEPARTMENT REVIEWED ALL ACCOUNTS THAT WERE WRITTEN OFF TO BAD DEBT. THE ACCOUNTS WERE RESEARCHED TO SEE IF PATIENTS HAD JOBS, ETC. AND WERE DETERMINED AT THAT POINT IF HE/SHE WOULD HAVE QUALIFIED FOR FINANCIAL ASSISTANCE. PART III, LINE 4: SEE ATTACHED AUDITED FINANCIAL STATEMENTS PAGES 10-11. PART III, LINE 8: MEDICARE ALLOWABLE COSTS WERE TAKEN DIRECTLY OFF MEDICARE COST REPORT FILED WITH THE 6/30/25 YEAR END. THE CALCULATION INCLUDED MEDICARE INPATIENT AND OUTPATIENT CHARGES LESS MEDICARE REIMBURSEMENT LESS GME RECEIVED. THE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT AS THE REIMBURSEMENT RECEIVED DID NOT COVER THE COST OF PROVIDING SERVICES. PART VI, LINE 3: PATIENTS ARE INFORMED OF PATIENT ASSISSTANCE AT TIME OF REGISTRATIONS, BY THE DISCHARGE NURSE, IF INPATIENT, AND ARE MAILED A LETTER. PART VI, LINE 4: THE POPULATION OF CUMBERLAND COUNTY, KY IS APPROXIMATELY 6,800. CUMBERLAND COUNTY HOSPITAL QUALIFIES FOR A DISPROPORTIONATE SHARE PAYMENT ON THEIR MEDICARE COST REPORT DUE TO THE LARGER THAN NORMAL SHARE OF MEDICAID PATIENT VOLUME SERVED BY THE HOSPITAL. NEARLY 35% OF THE COUNTIES' RESIDENTS ARE ENROLLED IN MEDICAID. PART VI, LINE 5: THE COMMUNITY HEALTH FAIR IS A HUGE SUCCESS. IT IS AN EXCELLENT WAY FOR THE HOSPITAL TO SHARE IMPORTANT HEALTH INFORMATION WITH THE COMMUNITY. CUMBERLAND COUNTY HOSPITAL ALSO HAS RADIO SPOTS ON THE LOCAL RADIO STATION TO DISCUSS SPECIFIC HEALTH NEEDS AND TO SHARE HEALTH INFORMATION WITH THE COMMUNITY X X 0 0 0 0 0 0 0 0 0 DR ROBERT FLOWERS SR PHYSICIAN 356905 0 1851 0 376797 0 10350 0 7898 0 753801 0 0 0 DR ROBERT FLOWERS JR DO PHYSICIAN/CHIEF OF STAFF 296026 0 1851 0 288846 0 9528 0 26376 0 622627 0 0 0 DR SAMUEL RICE MD FORMER CHIEF OF STAFF 295706 0 1778 0 146482 0 0 0 15795 0 459761 0 0 0 DR LAUREN DYER-HURT PHYSICIAN 277820 0 1851 0 0 0 8427 0 7898 0 295996 0 0 0 DR CHRISTIAN KONSAVAGE PHYSICIAN 243896 0 1789 0 0 0 0 0 857 0 246542 0 0 0 VICTORIA KINGREY DIRECTOR BFT/APRN 187229 0 1818 0 0 0 5732 0 8679 0 203458 0 0 0 MEGAN SELLS PHARMACIST 165397 0 1851 0 0 0 4669 0 16700 0 188617 0 0 0 RICHARD NEIKIRK II CEO 165222 0 1834 0 0 0 5060 0 8285 0 180401 0 0 0 RICHIE CAPPS FORMER CFO 159299 0 1851 0 0 0 4902 0 8918 0 174970 0 0 0 LORI BETH CASH CFO 144215 0 1851 0 0 0 4447 0 3850 0 154363 0 0 0 SCH J, PART II DR. ROBERT FLOWERS, SR., DR. SAMUEL RICE AND DR. ROBERT FLOWERS, JR., WERE W-2 EMPLOYEES AT BFT CLINIC AND INDEPENDENT CONTRACTORS FOR ER COVERAGE FOR THE YEAR. DR. ROBERT FLOWERS, SR.'S TOTAL COMPENSATION CONSISTS OF $376,796.5 OF 1099-NEC COMPENSATION. THE REST IS W-2 WAGES. DR. RICE'S TOTAL COMPENSATION CONSISTS OF $146,481.98 OF 1099-NEC COMPENSATION. THE REST IS W-2 WAGES. DR. ROBERT FLOWERS, JR'S TOTAL COMPENSATION CONSISTS OF $288,846.27 OF 1099-NEC COMPENSATION. THE REST IS W-2 WAGES. A CUMBERLAND HEALTH SERVICES CORPORATION 611180160 000000000 2012-04-18 8500000 PROCEEDS SPENT TO RENOVATE AND CONSTURCT AN ADDITION TO THE HOSPITAL. 0 0 0 A 1487500 8500000 38000 8462000 2014 0 0 1 1 A 0 0 0 0 0 0 1 A 0 0 1 0 0 0 0 0 1 A 1 PEGGY FLOWERS MOTHER OF DR. ROBERT FLOWERS JR. (BOD) 158072 COMPENSATION 0 RACHEL NEIKIRK SISTER OF RICH NEIKIRK II, CEO AND DAUGHTER OF RICH NEIKIRK, SR. VICE CHAIR 43780 COMPENSATION 0 MARY GRAVES SPOUSE OF HARVEY GRAVES, BOD 110339 COMPENSATION 0 TREVOR GRAVES SON OF HARVEY GRAVES, BOD 54263 COMPENSATION 0 CANDICE HOSTETLER DAUGHTER OF HARVEY GRAVES, BOD 109422 COMPENSATION 0 RICHARD NEIKIRK SR FATHER OF RICHARD NEIKIRK II, CEO 126859 COMPENSATION 0 FORM 990, PART VI, SECTION A, LINE 2 RICHARD NEIKIRK SR., VICE CHAIRMAN OF THE BOARD, IS THE FATHER OF RICH NEIKIRK II, CEO. FORM 990, PART VI, SECTION A, LINE 6 PER THE BY-LAWS, ANY PERSON OR ENTITY HAVING ITS PRINCIPAL OFFICE IN CUMBERLAND COUNTY, KY AND HAVING CUMBERLAND COUNTY, KY AS THE PRINCIPAL AREA OF ITS ACTIVITY MAY BECOME A MEMBER OF THE HOSPITAL ASSOCIATION. TO BECOME A MEMBER OF THE ASSOCIATION, A DONATION OF $100 MUST BE MADE TO THE ASSOCIATION. NINE DIRECTORS OF THE TEN DIRECTOR BOARD MAY BE ELECTED BY THE MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A PER THE BY-LAWS, ANY PERSON OR ENTITY HAVING ITS PRINCIPAL OFFICE IN CUMBERLAND COUNTY, KY AND HAVING CUMBERLAND COUNTY, KY AS THE PRINCIPAL AREA OF ITS ACTIVITY MAY BECOME A MEMBER OF THE HOSPITAL ASSOCIATION. TO BECOME A MEMBER OF THE ASSOCIATION, A DONATION OF $100 MUST BE MADE TO THE ASSOCIATION. NINE DIRECTORS OF THE TEN DIRECTOR BOARD MAY BE ELECTED BY THE MEMBERS. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 IS PRESENTED TO THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ALL CONTRACTS AND OTHER AGREEMENTS ARE REVIEWED BY MANAGEMENT TO ENSURE THAT NO CONFLICTS EXIST OR HAVE THE ABILITY TO ARISE. THE BOARD OF DIRECTORS MUST VOTE ON THE POLICY IF A CONFLICTING EVENT ARISES AND A CONFLICTING BOARD MEMBER MUST ABSBTAIN FROM VOTING. FORM 990, PART VI, SECTION B, LINE 15 LINE 15A: THE CEO'S SALARY IS DETERMINED BY THE BOARD OF DIRECTORS. SALARY SURVEYS ARE OBTAINED FROM THE KENTUCKY HOSPITAL ASSOCIATION FOR THE TOP MANAGEMENT POSITIONS. THE INDEPENDENT BOARD UTILIZES THESE SALARY SURVEYS IN SETTING COMPENSATION FOR THESE POSITIONS. THE CEO'S SALARY IS REVIEWED BY THE BOARD ANNUALLY AND IS DOCUMENTED WITHIN THE BOARD MINUTES AND EXECUTIVE MINUTES. LINE 15B: THE CFO'S SALARY IS DETERMINED BY THE BOARD OF DIRECTORS. THE COO'S SALARY IS DETERMINED BY THE CEO. SALARY SURVEYS ARE OBTAINED FROM THE KENTUCKY HOSPITAL ASSOCIATION FOR THE TOP MANAGEMENT POSITIONS INCLUDING THE CFO AND COO. EACH EMPLOYEE IS EVALUATED ANNUALLY BY THEIR DEPARTMENT DIRECTOR TO DETERMINE IF A CHANGE IN SALARY IS WARRANTED. THE DIRECTORS ARE EVALUATED BY ADMINISTRATION ANNUALLY. THIS PROCESS IS REVIEWED AND DOCUMENTED WITHIN THE BOARD MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. SCHEDULE H, PART VII FORMER CFO RICHIE CAPPS IS STILL EMPLOYED BY CCHA AFTER STEPPING DOWN FROM THE CFO POSITION. BEGINNNING JANUARY 1, 2024 HE BECAME A SENIOR ADVISOR IN WHICH IS COMPENSATED FOR HIS SERVICES IN THAT ROLE. FORMER CHIEF OF STAFF DR. SAMUEL RICE, M.D. IS STILL EMPLOYED BY CCHA AFTER STEPPING DOWN FROM HIS POSITION AS CHIEF OF STAFF. BEGINNNING JANUARY 1, 2024 HE BECAME A SENIOR ADVISOR IN WHICH IS COMPENSATED FOR HIS SERVICES IN THAT ROLE, IN ADDITION TO HIS SEPARATE CONTRACT WORK FOR MEDICAL SERVICES PROVIDED (SEE SCHEDULE J SUPPLEMENTAL INFORMATION). FORM 990, PART IX, LINE 11G PROFESSIONAL MEDICAL FEES: PROGRAM SERVICE EXPENSES 640,377. MANAGEMENT AND GENERAL EXPENSES 372,120. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,012,497. CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 732,198. MANAGEMENT AND GENERAL EXPENSES 425,476. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,157,674. COLLECTION FEES: PROGRAM SERVICE EXPENSES 34,739. MANAGEMENT AND GENERAL EXPENSES 20,187. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 54,926. FORM 990, PART VI, LINE 1A THE PRESIDENT, VICE PRESIDENT, SECRETARY/TREASURER AND CHIEF OF MEDICAL STAFF (EX-OFFICIO BOARD MEMBER) SHALL CONSTITUTE THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS AND SHALL CONDUCT THE BUSINESS AFFAIRS OF THE CORPORATION AS THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS AND SHALL BE AUTHORIZED, WITHOUT EXPRESSED AUTHORITY OF THE BOARD, TO DO AND PERFORM ANY AND ALL ACTS NECESSARY IN THE OPERATION OF THE CORPORATION'S BUSINESS, PROVIDING THAT ANY ACTION IT MAY TAKE WILL NOT BE IN EXPRESS CONFLICT WITH THE POLICIES AND EXPRESS WISHES OF THE BOARD OF DIRECTORS. CAPPS PHARMACY DBA CUMBERLAND CTY PHAR 333 KEEN ST BURKESVILLE KY 42717 611318396 PHARMACY KY CUMBERLAND COUNTY HOSPITAL ASSOCIATION C 446746 2125104 1.00000 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 CAPPS PHARMACY A 66000 FMV CAPPS PHARMACY P 786143 FMV