Putnam County Rural Health Clinic, Inc.

Putnam County Rural Health Clinic, Inc. General Information Contact Information Nonprofit Putnam County Rural Health Clinic, Inc. Address P.O. Box 175 319 W Broad St Baxter, TN 38544 Phone (931) 858-2116 Fax 931 858-2117 Email pcrhc@aol.com At A Glance Year of Incorporation 1999 BAXTER MEDICAL CLINIC Former Names Putnam County Rural Health Clinic 1

Mission & Impact Statements Mission The Mission of the Putnam County Rural Health Clinic is first to provide access to affordable health care for the rural population of Putnam County, and adjacent rural counties, regardless of their ability of pay. The second part of our focus is health education services. Our educational efforts are to encourage greater participation in healthy living by providing information and tools to assist our patients in making better health judgments. Background Health Clinics were operated as both non-profit and for-profit for over 15 years, in Baxter and Monterey, but were closed in 1999. Dr. Kenna Williams, a general surgeon practicing in Cookeville, along with community leaders, recognized this as a significant loss of access to primary care for residents of the area. Manpower and financial support were mobilized at the grass-roots level in order to restructure and reopen as a non-profit corporation, 501c3. Thus began the Putnam County Rural Health Clinic, Inc. This Clinic, located in Baxter, is important to the area it serves because it assists in eliminating disparities. By easing access to medical care, for people less able to use existing health services miles away, health outcomes can be improved. Such improvements come by a staff developing a sustain partnership with our patients and practicing in the context of family and community. This relationship can lead to better informed and better health outcomes for the people we serve. We closed the Monterey clinic because of lack of income. Many of those patients come to Baxter (20 miles away) Impact We are definitely in a forward movement. We have 2 doctors (general practitioner & surgeon) and a nurse practitioner, as well as a third doctor who has just started that will help those who have psychological problems. They all work part time, one volunteers. We are open 5 days a week (3 full days and 2-1/2 days. We have increased our patient count by 45%. We also have had success in the educational aspect, some of our customers have made improvements in their eating habits which has improved their health. One patient had her cholesterol go from 293 to 174. Local churches had a room remodeled for us for the surgeon (minor surgery). This has improved the workflow by increasing work space. There will be a lot of focus on the mental aspect of our patients by our added physician this year. Needs 1. Increase funding to provide consistent affordable primary care to this rura1 community. 2. Seek ways to assist patients in obtaining specialty care as needed. 3. Increase more health education opportunities in the community. 4. More advertisement (in forms of material and radio) to make patients aware of our quality of service. 5. More equipment (medical and office staff) is really needed. Service Categories Primary Organization Category Health Care / Community Health Systems Secondary Organization Category Education / Areas of Service Areas Served TN - Cumberland TN - Dekalb TN - Jackson TN - Overton 2

TN - Putnam TN - Smith TN - White Our Clinic serves Baxter, Tennessee and surrounding rural area. The area is geographically diverse and without public transportation; rural roads get these, primarily disadvantaged persons, to our Clinic. Board Chair Statement It has been several years since two dedicated nurse practitioners and other concerned community members came together to consider what could be done to avoid closing this rural clinic in Putnam County. The clinic had served, for many years, as the point of access to the only health care that some people in the region received. As one nurse put it, "Many of my patients just won't make it if they lose this clinic." We all knew that this rural Clinic would not be a money-making endeavor and that the only way we could see the clinic remain open would be to establish a not-for-profit corporate structure. I can confirm that the concerns which were present then are even more compelling now. Many of our patients have become uninsured persons, following the national upward trend in numbers of uninsured. We are determined to continue our efforts for our patients and community's good. CEO Statement These clinics serve a need that is not being met by other offices or clinics most of which are 15 to 35 miles away from these rural citizens. We have received such warm thanks from many patients who are happy to be served locally and in such a warm and courteous manner. This letter we received truly reflects the atmosphere we wish to convey. "After about my 20th visit to the ER and other clinics for my severe illness which gives me pain, I found out about the Baxter Clinic, as it turns out, which is less than two miles from my house. As a result of this clinic I can now lead a fairly normal life. I can't begin to tell you what this means to a person. I have always been known as a person who cares and gets involved when I can help but I never expected to find, in one small town and one small clinic, that many caring people; from the receptionist to doctor. I have watched their interaction with other people with all sorts of illnesses and all walks of life. Without exceptions these people are treated with courtesy and care and treatment all of which the most expensive clinics in the country may be able to match but certainly not surpass. Having been all over the world and seen a lot of terrible things, I have tended to become very cynical. These volunteers restored my faith in the goodness of people and reminded me that there are caring people left in the world. CCB" 3

Programs Programs Mindfulness Description The two year project will provide awareness, psychoeducation and pain management training. The proposed intervention will focus on nonmedical pain management for persons wtih acute and chronic illnesses or injuries.pain is a critical issue for many of our patients of the Baxter Medical Clinic and other medical providers. Many face constant struggle for improved quality of life due to their intense pain. Their struggle often leads to extensive use of medications, which in turn creates negative side effects,loss of mental acuity and the possibility of addiction. Mindulness training will offer an evidence-based alternative shown in numerous outcome studies to facilitate the management of pain, resulting in improved quality of life and reduced reliance on medication. The project will utilize evidnece-based techniwues developed b y Dr. Jon Kabat-Zinn, Professor of Medicine Emeritus, University of Massachusetts Medical Center. The techniques involve weekly sessions using a proven training curriculum. Budget 27500 Category Population Served Short Term Success Long term Success Program Success Monitored By Examples of Program Success Health Care, General/Other Health Diagnostic, Intervention & Treatment Services Adults, Elderly and/or Disabled, Aging, Elderly, Senior Citizens This is a two year project which we expect to be an ongoing adventure. We actually have already started it. Dr. Rod Ellis, who is in charge, started out on Saturday only but has already decided to meet with patients on Wednesday morning also. The patients have been much more receiptive than anticipated. So our fear of them acccepting this has already been alievated. If 60% of the patients will actually participate, then we expect a 75% improvement which equates to 45% which would be a success. The long term success is hopefully to educate and train our patients to do preventative measures for good health. For those in pain, an alternative from reliance on medication to an evidence-based tehnique developed by Dr. Jon Kabat-Zinn, Professor of Medicine Emeritus, University of Massachusetts Medical Center. Program will be evaluated independently. Outcomes will include improved capacity to manage pain as measured by the SUDS. Data will be collected on an ongoing basis and results reviewed at 6 mo intervals. The only success as of today is the patients willing to accept this. We have had no time for measuring results yet. 4

Primary health care to low income, TennCare and uninsured patients Description Putnam County Rural Health Clinic, Inc. consists of one clinic in Baxter, Tennessee, the Baxter Medical Clinic. The clinic served 2,571 patients this year. The clinic is housed in space donated by the City of Baxter, has approximately 1500 square feet. The population of Baxter is 1379 (US census 2010). Today 50% of our patients are on TennCare; 23% are uninsured. and our insured/self-pay patients are at 27%. Budget 27500 Category Population Served Long term Success Diseases, Disorders & Medical Disciplines, General/Other Diabetes Adults, Aging, Elderly, Senior Citizens, At-Risk Populations The long term effects of this program will be to create a group of more healthy older adults who have less complications from diabetes such as vision loss and blindness, heart disease, and neuropathy. We are finding that the greatest problem we have is getting patients to return to the clinic for follow-up visits to measure their blood sugar to determine whether there is a need to alter the dosage of medication. We are getting a return rate of less than 40 per cent on a regular basis. We are studying what reasons might we approve in order to increase that number 2 fold. CEO Comments The lack of access to quality health care in Baxter and adjacent rural areas is a real issue for the people who live in these beautiful rolling hills. However, it is not only our mission but also an opportunity for the Putnam County Rural Health Clinic to provide services to this group. Our clinic is the only primary care provider in this region. We have continued to see an increase in the number of patients served and expect to continue a steady increase. Our fees are based on the Medicare fee schedule, but no one is turned away for inability to pay. Because of continuing TennCare cuts, more patients are uninsured. Indigent care is expected to be supported through grants, donations and community fundraising. Our volunteer efforts are strong and continue to be a great source of support, both to our health care staff and our administrative staff. 5

Governance Board Chair Board Chair Mrs. Susan O'Connor Company Affiliation TN Technological University, Retired Term Jan 2012 to Jan 2014 Board Members Name Affiliation Status Dr. Rodney Ellis University of Tennessee Voting Mr. Craig P Fickling Voting Jeff Herald Community Volunteer Voting Chief Danny Holmes Baxter Polic Dept. Chief Voting Ms. June Lewis Voting Ms. Sue Neal Bank of Putnam County Voting Mrs. Susan O'Connor TN Early Intervention, Retired Voting Ms. Vickie Palmer Pharmacist, Nunally Drugs Voting Mrs. Melinda Swafford Ph D Tenn. Tech. University Voting Ms. Kenna Williams MD General Surgery Voting Board Demographics - Ethnicity African American/Black 0 Asian American/Pacific Islander 0 Caucasian 9 Hispanic/Latino 0 Native American/American Indian 1 Other 0 Cherokee Indian Board Demographics - Gender Male 4 Female 6 Unspecified 0 Governance Board Term Lengths 3 Board Term Limits 0 Board Meeting Attendance % 65% Written Board Selection Criteria? Written Conflict of Interest Policy? 6

Percentage Making Monetary Contributions 89% Percentage Making In-Kind Contributions 100% Constituency Includes Client Representation Number of Full Board Meetings Annually 10 Board CoChair Board CoChair PHD Melinda Swafford Company Affiliation TTU Term July 2012 to June 2013 Standing Committees Board Governance Development / Fund Raising Executive Finance Special Events Strategic Planning Risk Management Provisions Commercial General Liability Commercial General Liability & D and O & Umbrella or Excess & Automobile & Professional Computer Equipment & Software Directors & Officers Policy Medical Health Insurance Medical Malpractice Workers Compensation & Employers' Liability CEO Comments The Board of Directors took control of the management of the clinics in March of 2007 when it became obvious that more money was being spent than was coming in and there were no large donation of money coming sufficient enough to pay the bills. It was necessary to reduce staff in order to become fiscally responsible, and that action was taken. With the help of dedicated volunteers, the clinics remained open and continued to serve the communities on a limit basis. Frugal management resulted in hiring our first paid staff member in 6 months, a nurse practioner, in January for one 8 hour day per week. By March, we could hire another one for an average of 6 hours per week. Slowly, all the outstanding bills were paid and at the end of the fiscal year, we have enough money going into the next fiscal year with a small reserve. It has been a great year with the commarade displayed by the Board and volunteers. 7

Management Executive Director/CEO Executive Director Ms. Sue Neal Term Start Mar 2007 Email sneal@bpc-financial.com Experience Community President of Bank of Putnam County, County Commissioner,Active in Chamber of Commerce, American Red Cross, Senior Citizens groups and many others. Former CEOs Name Term Ms. Jane Kissane June 2004 - Mar 2007 Staff Full Time Staff 0 Part Time Staff 6 Volunteers 3 Contractors 1 Retention Rate 0% Plans & Policies Does the organization have a documented Fundraising Plan? Does the organization have an approved Strategic Plan? Number of years Strategic Plan Considers 3 When was Strategic Plan adopted? Aug 2007 In case of a change in leadership, is a Management Succession plan in place? Does the organization have a Policies and Procedures Plan? Does the organization have a Nondiscrimination Policy? Does the organization have a Whistle Blower Policy? Does the organization have a Document Destruction Policy? 8

Financials Fiscal Year Fiscal Year Start July 01 2012 Fiscal Year End June 30 2013 Projected Revenue $227,527.00 Projected Expenses $227,527.00 Endowment Value $0.00 Endowment Spending Policy N/A Endowment Spending Percentage (if selected) 0% Detailed Financials Revenue and Expenses Total Revenue $204,909 $255,558 $219,393 Total Expenses $216,820 $287,496 $196,638 Revenue Sources Foundation and Corporation $0 $0 $0 Contributions Government Contributions $3,030 $13,538 $56,478 Federal $0 $0 $0 State $3,030 $13,538 $56,478 Local $0 $0 $0 Unspecified $0 $0 $0 Individual Contributions $60,117 $45,625 $24,320 Indirect Public Support $0 $0 $0 Earned Revenue $85,755 $125,576 $60,348 Investment Income, Net of Losses $0 $0 $0 Membership Dues $0 $0 $0 Special Events $0 $0 $0 Revenue In-Kind $55,650 $0 $77,505 Other $357 $70,819 $742 9

Expense Allocation Program Expense $192,013 $256,753 $156,063 Administration Expense $24,807 $30,743 $40,575 Fundraising Expense $0 $0 $0 Payments to Affiliates $0 $0 $0 Total Revenue/Total Expenses 0.95 0.89 1.12 Program Expense/Total Expenses 89% 89% 79% Fundraising Expense/Contributed Revenue 0% 0% 0% Assets and Liabilities Total Assets $14,630 $27,664 $15,078 Current Assets $12,515 $13,590 $13,269 Long-Term Liabilities $38,435 $35,829 $26,174 Current Liabilities $36,464 $26,602 $5,323 Total Net Assets ($60,269) $14,074 ($16,419) Short Term Solvency Current Ratio: Current Assets/Current Liabilities 0.34 0.51 2.49 Long Term Solvency Long-Term Liabilities/Total Assets 263% 130% 174% Top Funding Sources Top Funding Source & Dollar Amount Patient Services $85,755 Patient Services $125,576 -- Second Highest Funding Source & Dollar Cash contributions Cash Contributions -- Amount and donations $60,117 and Donations $45,625 Third Highest Funding Source & Dollar Amount Contributed Services (In-Kind) $55,650 State of Tennessee $13,538 -- Capital Campaign Is the organization currently conducting a Capital Campaign for an endowment or the purchase of a major asset? No Capital Campaign Goal $0.00 Capital Campaign Raised-to-Date Amount $0.00 as of 0 Capital Campaign Anticipated in Next 5 Years? No State Charitable Solicitations Permit TN Charitable Solicitations Registration - Expires Dec 2015 Registration No 0 Organization Comments A strong management team is essential for success of this Clinic. The Board sets policies and procedures and makes sound decisions to assure financial viability and cost competitiveness. The management team makes operational these procedures and decisions. The Executive Director has authority to manage day-to-day 10

operations. All staff members are accountable to the Executive Director and the Executive Director is accountable to the Board of Directors. Monthly, the Board is provided information on utilization and finances. Also monthly, revenues and expenses are reviewed against the operating budget, billing is completed, and collection is done. In addition, the Clinic undergoes an annual independent financial audit. Our last audit, conducted in January 2012, found that the financial statements present fairly, in all material respects, the financial position of Putnam County Rural Health Clinic, Inc. GivingMatters.com Financial Comments Financial figures taken from the audit. Audit was conducted by Denning & Cantrell, PLLC. Comments provided by Laurel Fisher 4/23/13. Created 04.17.2018. Copyright 2018 The Community Foundation of Middle Tennessee 11