Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | ||||||
| 6 | Total. Add lines 1 through 5 | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support. (Subtract line 7c from line 6.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
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| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2019 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2019 |
(iii) Distributable Amount for 2019 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2019 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2019: | ||||
| a From 2014....... | ||||
| b From 2015....... | ||||
| c From 2016....... | ||||
| d From 2017....... | ||||
| e From 2018....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2019 distributable amount | ||||
|
i
Carryover from 2014 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2019 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2019 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2020. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2015..... | ||||
| b Excess from 2016..... | ||||
| c Excess from 2017..... | ||||
| d Excess from 2018..... | ||||
| e Excess from 2019..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART I, LINE 3 | ----------------------------------- BARREN RIVER REGIONAL CANCER CENTER'S PUBLIC CHARITY CLASSIFICATION HAS BEEN DESIGNATED AS A HOSPITAL DESCRIBED IN SECTION 170(B)(1)(A)(III) BY THE IRS. SCHEDULE H HAS NOT BEEN COMPLETED BY BARREN RIVER REGIONAL CANCER CENTER AS IT DOES NOT OPERATE A STATE LICENSED HOSPITAL FACILITY. |
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART III, LINE 4A | PROGRAM SERVICE ACCOMPLISHMENTS ------------------------------- THE BARREN RIVER REGIONAL CANCER CENTER, INC. ("CANCER CENTER") WAS ESTABLISHED AND OPENED APRIL 1, 2003 TO ACT AND OPERATE EXCLUSIVELY FOR CHARITABLE PURPOSES BECAUSE OF AN INCREASING NEED FOR RADIATION THERAPY SERVICES IN SOUTH-CENTRAL KENTUCKY. ONCE A SPECIFIC PLAN FOR TREATING THE PATIENT'S CANCER IS DEVELOPED, WE GO TO WORK. ADVANCED EQUIPMENT SENDS CANCER-FIGHTING RADIATION TO THE TUMOR. CAREFUL FOLLOW-UP AND CLOSE PHYSICIAN SUPERVISION ENSURE THE BEST POSSIBLE OUTCOME. RADIATION THERAPY IS A PRIMARY THERAPY FOR BASAL CELL CARCINOMAS OF THE SKIN, EARLY STAGE LARYNGEAL CANCERS, OTHER HEAD AND NECK CANCERS, EARLY STAGE HODGKIN'S DISEASE, NON-HODGKIN'S LYMPHOMAS, EARLY STAGE BREAST CANCER FOLLOWING LUMPECTOMY, CERTAIN LUNG CANCERS, SEMINOMAS, CARCINOMAS OF THE CERVIX, PROSTRATE CANCERS, BLADDER CANCERS, ANAL CANCERS, CERTAIN PEDIATRIC TUMORS, AND SOME BRAIN TUMORS. RADIATION THERAPY MAY BE PERFORMED FOR CURATIVE, CANCER ELIMINATION, OR PALLIATIVE REASONS. IT MAY BE USED TO SUPPLEMENT OTHER PRIMARY TREATMENT MODALITIES. PREOPERATIVE RADIATION IS USED TO SHRINK THE SIZE OF A TUMOR TO ALLOW A LESS RADICAL OR DISFIGURING SURGICAL PROCEDURE. POSTOPERATIVE RADIATION THERAPY IS FREQUENTLY USED TO DECREASE THE RISK OF LOCAL RECURRENCES FOLLOWING SURGERY TO THE BREAST, LUNG, RECTAL CANCERS, HEAD AND NECK TUMORS, AND BRAIN TUMORS. RADIATION THERAPY MAY ALSO BE USED TO PROPHYLACTICALLY TREAT TISSUES OR ORGANS BEFORE DISEASE IS CLINICALLY EVIDENT. RADIATION THERAPY USES HIGH-ENERGY IONIZING RADIATION TO KILL CANCER CELLS BY DELIVERING A LETHAL DOSE OF RADIATION TO TUMOR TISSUE, WHILE DELIVERING AN ACCEPTABLE DOSE TO HEALTHY TISSUE. IT IS TYPICALLY DELIVERED IN A SERIES OF FIFTEEN-MINUTE TREATMENT SESSIONS FIVE DAYS A WEEK OVER A SIX-TO-EIGHT WEEK PERIOD. RADIATION TREATMENTS ARE PROVIDED TO AN ADULT AND GERIATRIC POPULATION. ALL TREATMENTS ARE ORDERED BY RADIATION ONCOLOGISTS, A PHYSICIAN WHO HAS SPECIALIZED IN THE MANAGEMENT AND TREATMENT OF CANCER CASES UTILIZING IONIZING RADIATION. TREATMENTS ARE ADMINISTERED BY LICENSED RADIATION THERAPISTS WHO HAVE HAD TRAINING IN BOTH DIAGNOSTIC AND THERAPEUTIC RADIOLOGY PROGRAMS. QUALITY CONTROL OVERSIGHT IS PROVIDED BY A MASTER'S DEGREE PHYSICIST WHO HAS SPECIFIC TRAINING IN MEDICAL PHYSICS. THE PHYSICIST IS ASSISTED IN QUALITY CONTROL AND DOSE CALCULATION AND MANAGEMENT BY A CERTIFIED MEDIAL DOSIMETRIST. A RADIATION ONCOLOGY NURSE IS ALSO AVAILABLE FOR PATIENT ASSESSMENT, EDUCATION, AND NUTRITIONAL ASSESSMENT AND TO MEET THE VARIOUS NEEDS OF THE PATIENT. THE SCOPE OF THIS FACILITY IS SOLELY TO PROVIDE EXTERNAL BEAM RADIATION TREATMENTS. THIS SIMPLY MEANS TREATMENTS ARE DELIVERED FROM AN EXTERNAL SOURCE. THE SOURCE OF RADIATION IS FROM A LINEAR ACCELERATOR WHICH CREATES HIGH ENERGY X-RAYS IN THE THERAPEUTIC DOSAGE RANGE FOR THE TREATMENT OF CANCER. DURING THE BARREN RIVER REGIONAL CANCER CENTER'S LATEST FISCAL YEAR ENDING MARCH 31, 2020, 206 NEW PATIENTS PRESENTED FOR CONSULTATION. THIS WAS A DECREASE OF 9% FROM THE PREVIOUS YEAR WHEN 227 PATIENTS RECEIVED CONSULTATION. THE CANCER CENTER DELIVERED 4,058 EXTERNAL BEAM TREATMENTS DURING FISCAL 2020 AND 4,375 TREATMENTS IN FISCAL 2019. IN ADDITION, 1,060 PREVIOUSLY TREATED PATIENTS WERE SEEN FOR FOLLOW-UP. |
| FORM 990, PART VI, SECTION A, LINE 3: | MANAGEMENT SERVICES AGREEMENT --------------------------------------------- THE BOARD HAS ENTERED INTO A MANAGEMENT AND TECHNICAL SERVICES SUPPORT SERVICES AGREEMENT WHEREBY DAY TO DAY OPERATIONS OF THE OUTPATIENT RADIATION THERAPY CENTER ARE PROVIDED BY OR MANAGED BY CLINICAL, SUPPORT AND MANAGEMENT STAFF OF THE BOWLING GREEN WARREN COUNTY COMMUNITY HOSPITAL CORPORATION, DBA THE MEDICAL CENTER. THE MEDICAL CENTER IS AN ACUTE CARE HOSPITAL THAT HAS OPERATED A HOSPITAL-BASED RADIATION THERAPY CENTER SINCE APRIL, 1983. THE HOSPITAL HAS HIGHLY SKILLED NURSES, THERAPISTS, DOSIMETRISTS, PHYSICISTS, ASSISTANTS, SUPPORT STAFF AND MANAGEMENT WHO SERVE THE BARREN RIVER REGIONAL CANCER CENTER, INC. PATIENTS AND THEIR FAMILIES. |
| FORM 990, PART VI, SECTION A, LINE 6: | MEMBERS -------------------------------- THE CORPORATION IS EQUALLY OWNED BY TWO NON-PROFIT ACUTE CARE HOSPITAL CORPORATIONS WHO EACH SERVE AS A MEMBER OF THE ENTITY. |
| FORM 990, PART VI, SECTION A, LINE 7A: | POWER OF MEMBERS -------------------------------------- EACH MEMBER OF THE CORPORATION MAY DESIGNATE THREE DIRECTORS AND SHALL HAVE THE EXCLUSIVE RIGHT TO DESIGNATE THE SUCCESSOR FOR THE DIRECTOR OR DIRECTORS THEY DESIGNATED. |
| FORM 990, PART VI, SECTION B, LINE 11: | 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. AT LEAST TWO WEEKS OF 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 -------------------------------------------- BOWLING GREEN WARREN COUNTY COMMUNITY HOSPITAL CORPORATION, INC. IS A 50% EQUITY HOLDER IN THE CORPORATION AND ALSO MANAGES THE CORPORATION'S DAILY ACTIVITIES. BOWLING GREEN WARREN COUNTY COMMUNITY HOSPITAL CORPORATION, INC. USES THE POLICIES OF ITS PARENT, NOT-FOR-PROFIT COMMONWEALTH HEALTH CORPORATION, AS A BASIS FOR POLICIES APPLIED TO THE CORPORATION. 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 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 NON-COMPLIANT ACTIVITY. CHC'S REGULATORY COMPLIANCE COMMITTEE (RCC) REVIEWS AND APPROVES ALL CONTRACTS FOR CHC AND/OR AFFILIATES. 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 OR INFORMATION THAT RELATES TO FAMILY MEMBERS. TRANSACTIONS ARISING ARE REVIEWED BY MANAGEMENT AS THEY OCCUR. |
| FORM 990, PART VI, SECTION C, LINE 19: | DOCUMENTS MADE 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 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; AND NO PROCESSES HAVE CHANGED FROM PRIOR YEAR. |
| FORM 990 PART IX LINE 11G | DESCRIPTION:COLLECTION AGENCY FEES TOTAL FEES:451 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:MEDICAL CONSULTING FEES TOTAL FEES:44085 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:OTHER PROFESSIONAL FEES TOTAL FEES:19914 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:CONTRACT FEES TOTAL FEES:147480 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:BILLING FEES TOTAL FEES:50690 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:EMPLOYEE SUPPORT FEES TOTAL FEES:802799 |
| Software ID: | |
| Software Version: |