2024-05-15T10:10:36-05:00 2023-06-30 390859910 BAKER TILLY US LLP 1570 FRUITVILLE PIKE SUITE 400 LANCASTER PA 17601 990 2022-10-01 264183569 KING'S DAUGHTERS MEDICAL SPECIALTIES INC KING 6064084000 2201 LEXINGTON AVENUE ASHLAND KY 41101 AUTUMN MCFANN TREASURER 6064084000 2024-05-13 1 AUTUMN MCFANN 999009999 1 KERRI N BOGDA CPA P00760402 7177404863 2024-05-13 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z SARA MARKS 2201 LEXINGTON AVENUE ASHLAND KY 41101 78783584 0 X WWW.KINGSDAUGHTERSHEALTH.COM X 2009 KY TO DELIVER QUALITY HEALTHCARE SERVICES WHICH PROVIDE VALUE TO THE PATIENT, PAYER, AND KDHS. 10 10 303 13 0 0 0 2950 83715401 78683950 5057 60200 186000 36484 83906458 78783584 0 0 0 0 96214673 82761886 0 0 0 19970280 13885933 116184953 96647819 -32278495 -17864235 20131901 14850266 12195414 11713075 7936487 3137191 X KING'S DAUGHTERS MEDICAL SPECIALTIES (KDMS) IS AN INTERGRATED SYSTEM OF MEDICAL SPECIALISTS AND PRIMARY CARE PHYSICIANS DESIGNED TO PROVIDE AN AVENUE FOR PHYSICIAN RECRUITMENT, RETENTION, AND EMPLOYMENT. CONTINUED ON SCHEDULE "O".KDMS PROVIDES ACCESS TO INFORMATION TECHNOLOGY, AS WELL AS LEADERSHIP AND DIRECTION IN A RAPIDLY TRANSFORMING HEALTHCARE ENVIRONMENT WITH CHANGING PAYOR DEMANDS. THE GOALS OF KDMS INCLUDE THE DELIVERY OF QUALITY SERVICE WHICH PROVIDES VALUE TO THE PATIENT, THE PAYOR, AND THE HEALTH SYSTEM. 0 0 96647819 0 78683950 KDMS HAS 30 MEDICAL SPECIALTIES PLUS PRIMARY CARE PHYSICIANS PROVIDING SERVICES IN 41 DIFFERENT LOCATIONS. THERE ARE 140 PHYSICIANS AND 115 ADVANCED PRACTITIONERS THAT MAKE UP THE PROVIDERS. KDMS SAW APPROXIMATELY 86,081 PATIENTS DURING FY2023 AND PROVIDED $1,214,995 OF CHARITY CARE. 96647819 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 0 0 303 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 1 1 0 1 1 0 0 0 1 1 1 1 1 1 1 0 KY X LAURIE STEWART CONTROLLER 6064089640 2201 LEXINGTON AVENUE ASHLAND KY 41101 DAVID JONES BOARD CHAIRMAN 0.25 6.25 X X 0 0 0 DR MARK NEWMAN BOARD VICE-CHAIRMAN (UNTIL 12/31/22) 0.25 5.75 X X 0 0 0 PENNY COX DIRECTOR 0.25 2.25 X 0 0 0 GINA DUGAS DIRECTOR 0.25 2.25 X 0 0 0 ROBERT DIPAOLA DIRECTOR 0.25 2.25 X 0 0 0 JOHN STEWART DIRECTOR 0.25 2.75 X 0 0 0 TOM BURNETTE DIRECTOR 0.25 2.75 X 0 0 0 STEPHEN ADDINGTON DIRECTOR 0.25 2.50 X 0 0 0 ERIC MONDAY DIRECTOR 0.25 2.25 X 0 0 0 CRAIG COLLINS DIRECTOR 0.25 2.25 X 0 0 0 MARK BIRDWHISTELL DIRECTOR 0.25 2.25 X 0 0 0 KRISTIE WHITLATCH PRESIDENT/CEO (10/1/22-12/31/22) 1.25 60.75 X 0 0 0 SARA MARKS PRESIDENT/CEO (BEG. 1/1/23) 1.25 60.25 X 0 1844834 142949 AUTUMN MCFANN TREASURER, SR VP/CFO/CAO 1.25 60.25 X 0 1897128 131808 SHERYL MAHANEY UNTIL 113022 SECRETARY, VP/CHIEF LEGAL OFFICER 1.25 60.75 X 0 1518132 8395 STEVEN CLIFTON SECRETARY (BEG. 12/1/22) 0.25 5.75 X 0 0 0 AMY SAUNDERS ASSISTANT SECRETARY (BEG. 12/1/22) 0.25 45.75 X 0 227968 12371 RODERICK TOMPKINS MD PHYSICIAN 40.00 0.00 X 1099030 0 48926 JENNIFER LISTERMAN MD PHYSICIAN 44.50 0.00 X 1511062 0 43177 ARTHUR GAING MD PHYSICIAN 40.00 0.00 X 1172043 0 38078 ZANE DARNELL MD PHYSICIAN 40.00 0.00 X 1972649 0 46334 OMRAN ABUL-KHOUDOUD MD PHYSICIAN 42.00 0.00 X 1172096 0 54634 6926880 5488062 526672 257 0 1 0 JACKSON & COKER HOLDINGS LLC PO BOX 277638 ATLANTA GA 303847638 LOCUM TENENS PHYSICIANS 1988649 HEALTH CAROUSEL LLC 400 SMITH ROAD SUITE 410 CINCINNATI OH 45209 LOCUM TENENS PHYSICIANS 1162753 UNIVERSITY PHYSICIANS AND SURGEONS INC 1400 MEDICAL CENTER DRIVE SUITE G5 HUNTINGTON WV 25701 PHYSICIANS 762451 BLUEGRASS ANESTHESIA ASSOCIATES 1140 CARTER AVENUE 2496 ASHLAND KY 41101 PHYSICIAN 748327 KEVIN WILLIS 91 PRIVATE DRIVE 1277 IRONTON OH 45638 PHYSICIAN 727501 20 2950 2950 NET PATIENT SERVICE RE 621110 78620376 78620376 MEANINGFUL USE REVENUE 900099 63574 63574 78683950 60200 60200 1242 0 1242 1242 1242 QUALITY INCENTIVE 900099 35242 35242 35242 78783584 78683950 0 96684 X 73782088 73782088 2505685 2505685 2937148 2937148 3536965 3536965 9815466 9815466 380 380 102240 102240 248261 248261 198 198 184215 184215 745115 745115 BAD DEBT EXPENSE 2590854 2590854 DUES & SUBSCRIPTIONS 108920 108920 PATIENT CARE AUTO EXPEN 66110 66110 OTHER - LESS THAN 5% 24174 24174 96647819 96647819 0 0 637224 239114 8693893 9618533 1188172 2814019 763302 452431 1244087 130141 1784695 1113946 7064615 612223 20131901 14850266 10575634 11085830 1619780 627245 12195414 11713075 X 7936487 3137191 7936487 3137191 20131901 14850266 X -17864235 13064939 X 0 1 X 1 0 X 1379977 2950 1382927 54133927 51182102 68093591 83715208 78683950 335808778 54133927 52562079 68093591 83715208 78686900 337191705 0 0 0 337191705 10191 3036 1683 1795 61442 78147 10191 3036 1683 1795 61442 78147 26980 182607 19484 184344 35242 448657 54171098 52747722 68114758 83901347 78783584 337718509 0.99840 0.99840 0.00020 0.00010 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MEDICAL RECORDS - 2018 AMOUNT: $ 20,979. 2019 AMOUNT: $ 75. QUALITY INCENTIVE - 2018 AMOUNT: $ 6,001. 2019 AMOUNT: $ 18,534. 2020 AMOUNT: $ 19,484. 2021 AMOUNT: $ 184,344. 2022 AMOUNT: $ 35,242. EMPLOYEE RETENTION CREDIT - 2019 AMOUNT: $ 163,998. SCHEDULE A, PAGE 3, PART III: KING'S DAUGHTERS MEDICAL SPECIALTIES, INC. FILED A SHORT YEAR RETURN FOR FISCAL YEAR END JUNE 30, 2023. 216000 5018 210982 1028087 125123 902964 1113946 KENTUCKY SALES TAX PAYABLE 15022 OPERATING LEASE LIABILITY 612223 627245 1 1 1 0 0 0 0 0 1 0 AUTUMN MCFANN TREASURER, SR VP/CFO/CAO 0 480101 0 138000 0 1279027 0 113725 0 18083 0 2028936 0 50000 ZANE DARNELL MD PHYSICIAN 1970791 0 0 0 1858 0 16975 0 29359 0 2018983 0 0 0 SARA MARKS PRESIDENT/CEO (BEG. 1/1/23) 0 464919 0 133500 0 1246415 0 113725 0 29224 0 1987783 0 50000 JENNIFER LISTERMAN MD PHYSICIAN 1510254 0 0 0 808 0 13725 0 29452 0 1554239 0 0 0 SHERYL MAHANEY UNTIL 113022 SECRETARY, VP/CHIEF LEGAL OFFICER 0 307303 0 0 0 1210829 0 0 0 8395 0 1526527 0 0 OMRAN ABUL-KHOUDOUD MD PHYSICIAN 1149738 0 0 0 22358 0 16975 0 37659 0 1226730 0 0 0 ARTHUR GAING MD PHYSICIAN 1167051 0 0 0 4992 0 16975 0 21103 0 1210121 0 0 0 RODERICK TOMPKINS MD PHYSICIAN 1075057 0 0 0 23973 0 16975 0 31951 0 1147956 0 0 0 AMY SAUNDERS ASSISTANT SECRETARY (BEG. 12/1/22) 0 190304 0 37219 0 445 0 10268 0 2103 0 240339 0 0 PART I, LINE 3 COMPENSATION FOR THE CEO IS DETERMINED BY ASHLAND HOSPITAL CORPORATION (RELATED ORGANIZATION) USING THE FOLLOWING METHODS: INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY/STUDY, AND APPROVAL BY THE BOARD/COMPENSATION COMMITTEE. PART I, LINES 4A-B THE FOLLOWING INDIVIDUALS RECEIVED A CHANGE-OF-CONTROL PAYMENT DURING THE CALENDAR YEAR 2022: - SHERYL MAHANEY $1,209,162 - SARA MARKS $1,175,614 - AUTUMN MCFANN $1,208,771 THESE WERE PAID AS A RESULT OF THE 12/1/22 MEMBER SUBSTITUTION WITH THE UNIVERSITY OF KENTUCKY. THE FOLLOWING INDIVIDUALS RECEIVED PAYMENTS FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: - AUTUMN MCFANN $18,996 - SARA MARKS $19,541 THE CEO AND CERTAIN VICE PRESIDENTS, WHOSE BENEFIT IN THE QUALIFIED TAX SHELTERED ANNUITY PLAN IS LIMITED DUE TO THE IRS COMPENSATION AND BENEFIT LIMITS, RECEIVE A BENEFIT RESTORATION CONTRIBUTION UNDER THE DEFERRED ANNUITY PLAN THAT IS PAID AS A TAXABLE DISTRIBUTION TO THE PARTICIPANT ANNUALLY. THE FOLLOWING INDIVIDUALS RECEIVED 457(F) EXECUTIVE RETENTION PLAN PAYOUTS: - AUTUMN MCFANN $50,000 - SARA MARKS $50,000 PART I, LINE 7 NONFIXED PAYMENTS ARE MADE AS A PART OF THE MEDICAL CENTER'S TEAM INCENTIVE AWARD (TIA) PLAN. ALL TEAM MEMBERS ARE ELIGIBLE FOR THE TIA. THE TIA IS PAID OUT BASED UPON SUCCESSFUL COMPLETION OF BOTH QUANTITATIVE AND QUALITATIVE STRATEGIC GOALS, SET ANNUALLY BY THE MEDICAL CENTER LEADERSHIP TEAM AND APPROVED BY THE BOARD OF DIRECTORS. FORM 990, PART V, LINE 1A: THERE IS NO SEPARATE FORM 1096 FILED BY KING'S DAUGHTERS MEDICAL SPECIALITIES, INC. ("KDMS"). ALL THE PAYMENTS ARE MADE BY ASHLAND HOSPITAL CORPORATION ("AHC"), AN AFFILIATE ENTITIY, UNDER ITS EIN 61-0444716. FORM 990, PART VI, SECTION A, LINE 6 ASHLAND HOSPITAL CORPORATION (AHC) IS THE SOLE CORPORATE MEMBER OF KING'S DAUGHTERS MEDICAL SPECIALTIES, INC. (KDMS). AHC, A 501(C)(3) ENTITY, IS THE PARENT ORGANIZATION OF AN INTEGRATED HEALTHCARE DELIVERY SYSTEM. FORM 990, PART VI, SECTION A, LINE 7A THE KDMS BOARD IS FOLDED INTO THE MAIN BOARD OF TRUSTEES OF AHC'S PARENT CORPORATION. THE BUSINESS OF KDMS IS AN AGENDA ITEM OF THE FULL BOARD INDEPENDENTLY OR THROUGH ITS COMMITTEE. FORM 990, PART VI, SECTION B, LINE 11B THE 990 WILL BE REVIEWED BY THE CFO AND CONTROLLER BEFORE IT IS FILED WITH THE IRS. THE 990 WILL BE KEPT ON FILE AND AVAILABLE FOR REVIEW BY BOARD MEMBERS UPON REQUEST. FORM 990, PART VI, SECTION B, LINE 12C KING'S DAUGHTERS MEDICAL CENTER REQUIRES ALL DIRECTORS, OFFICERS, AND KEY EMPLOYEES TO COMPLY WITH ITS CONFLICTS OF INTEREST POLICY, WHICH TRACKS THE IRS' RECOMMENDED POLICY WITH RESPECT TO SUCH OFFICERS AND DIRECTORS. MEMBERS OF THE MEDICAL CENTER'S BOARD OF DIRECTORS MUST ANNUALLY IDENTIFY, IN WRITING, ANY INTEREST THAT COULD GIVE RISE TO A CONFLICT, SUCH AS A LEADERSHIP POSITION IN A CONFLICTING ORGANIZATION; DISCLOSURE IS NOT LIMITED TO FINANCIAL CONFLICTS. LEADERSHIP EMPLOYEES MUST ANNUALLY CERTIFY, IN WRITING, THAT THEY KNOW OUR CONFLICTS OF INTEREST POLICY AND PROCEDURE AND HAVE NO CONFLICTS OF INTEREST. IN ADDITION, EMPLOYEES OF THE MEDICAL CENTER CERTIFY THAT NO CONFLICTS OF INTEREST EXIST OR OBTAIN AN ADVANCE WAIVER OF ANY CONFLICTS. THE MEDICAL CENTER'S HUMAN RESOURCES AND CORPORATE COMPLIANCE DEPARTMENTS MAINTAIN ALL RELEVANT DISCLOSURES AND SIGNATURES. ALL EMPLOYEES PROVIDE ANNUAL CONFLICT CHECKS. IF A CONFLICT OF INTEREST IS REPORTED, THE VICE PRESIDENT TO WHOM THE REPORTING EMPLOYEE DIRECTLY OR INDIRECTLY REPORTS, TOGETHER WITH THE CEO, CORPORATE COMPLIANCE OFFICER AND GENERAL COUNSEL, DETERMINES IF A CONFLICT EXISTS. IF THE REPORTING EMPLOYEE IS A VICE PRESIDENT, THE CEO, IN CONSULTATION WITH THE GENERAL COUNSEL, DETERMINES IF A CONFLICT EXISTS. ANNUALLY, BOARD MEMBERS DISCLOSE PERSONAL AND PROFESSIONAL RELATIONSHIPS TO THE SECRETARY OF THE BOARD. IF A POTENTIAL CONFLICT EXISTS, THE BOARD SECRETARY OR A BOARD MEMBER WILL IDENTIFY THE CONFLICT, OR POTENTIAL CONFLICT, AND THE BOARD MEMBER WILL BE REMOVED FROM ANY PART OF THE DECISION-MAKING PROCESS, AND HAS NO ROLE IN THE INSTANCE IN WHICH THE CONFLICT EXISTS. A BOARD MEMBER WHO HAS A CONFLICT OF INTEREST MUST ABSTAIN FROM ANY RELEVANT DISCUSSION OR VOTE. IF A CONFLICT OF INTEREST IS DISCOVERED AFTER THE FACT, THE CEO AND VICE PRESIDENT, TOGETHER WITH THE GENERAL COUNSEL, IF APPROPRIATE, REVIEW THE INSTANCE IN WHICH THE CONFLICT OCCURRED. THOSE LEADERS DETERMINE WHETHER THE CONFLICTED INDIVIDUAL INFLUENCED THE DECISION-MAKING OR PROFITED FROM THE CONFLICT. THE CONFLICTED INDIVIDUAL IS REMOVED FROM ANY FURTHER INVOLVEMENT. IN ADDITION, ANY FAILURE TO REPORT CONFLICTS OF INTEREST VIOLATES THE MEDICAL CENTER'S POLICY AND COULD RESULT IN DISCIPLINARY ACTION, UP TO AND INCLUDING TERMINATION OF EMPLOYMENT OR REMOVAL FROM THE MEDICAL CENTER'S BOARD OF DIRECTORS. MEDICAL STAFF MEMBERS ARE REQUIRED BY THE MEDICAL STAFF BYLAWS TO DISCLOSE CONFLICTS OF INTEREST. ONCE DISCLOSED, THE MEDICAL STAFF MEMBER IS REMOVED FROM ANY DISCUSSION, DECISION-MAKING, AND/OR VOTE ON ANY RELATED ISSUE. FORM 990, PART VI, SECTION B, LINE 15 AT THE DIRECTION OF THE BOARD OF DIRECTORS, KDMC SET COMPENSATION FOR THE TEAM MEMBERS AND LEADERS USING LOCAL, REGIONAL AND NATIONAL SALARY INFORMATION PROVIDED THROUGH SURVEY DATA. THE PRIMARY OBJECTIVE OF KING'S DAUGHTERS COMPENSATION PHILOSOPHY IS TO HAVE COMPENSATION AND BENEFITS SET THAT REFLECT OTHER SIMILAR INDEPENDENT NOT FOR PROFIT HEALTHCARE SERVICES AS WELL AS THE WORK PERFORMANCE OF THE ORGANIZATION. MERCER, AN INDEPENDENT COMPENSATION EXPERT, PERIODICALLY PERFORMS A REVIEW OF EXECUTIVE COMPENSATION AND BENEFITS. SULLIVAN COTTER, AN INDEPENDENT COMPENSATION EXPERT, PROVIDES ANNUAL MARKET SURVEY DATA FOR PHYSICIAN COMPENSATION AND BENEFITS WHICH IS USED FOR DETERMINATION OF FAIR MARKET VALUE. FORM 990, PART VI, SECTION C, LINE 19 ON A QUARTERLY BASIS, THE FINANCIAL STATEMENTS ARE REPORTED TO THE MUNICIPAL SECURITIES RULEMAKING BOARD AND MADE AVAILABLE ON THEIR WEBSITE. GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 4,289,492. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,289,492. LOCUM TENENS: PROGRAM SERVICE EXPENSES 5,141,220. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,141,220. MEDICAL DIRECTORSHIPS: PROGRAM SERVICE EXPENSES 382,819. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 382,819. OTHER PROGRAM SERVICES EXPENSE: PROGRAM SERVICE EXPENSES 1,935. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,935. FORM 990, PART XI, LINE 9: FORGIVENESS OF INTERCOMPANY PAYABLE 20,245,940. FASB TO GASB CONVERSION -7,181,001. ASHLAND HOSPITAL CORPORATION 2201 LEXINGTON AVENUE ASHLAND KY 41101 610444716 HEALTHCARE KY 501(C)(3) LINE 3 ROYAL BLUE HEALTH LLC 0 ASHLAND NURSING HOME CORPORATION 2500 STATE ROUTE 5 ASHLAND KY 41102 611386016 NURSING HOME KY 501(C)(3) LINE 10 ASHLAND HOSPITAL CORPORATION 0 KENTUCKY MEDICAL LOGISTICS INC 425 22ND STREET ASHLAND KY 41101 264736971 MEDICAL TRANSPORT KY 501(C)(3) LINE 10 ASHLAND HOSPITAL CORPORATION 0 KING'S DAUGHTERS HEALTH SYSTEM 2201 LEXINGTON AVENUE ASHLAND KY 41101 274553836 HEALTHCARE KY 501(C)(3) LINE 12B, II N/A 0 PORTSMOUTH HOSPITAL CORPORATION 1901 ARGONNE AVENUE PORTSMOUTH OH 45662 453215312 HEALTHCARE OH 501(C)(3) LINE 3 ROYAL BLUE HEALTH LLC 0 KENTUCKY HEART FOUNDATION INC 2201 LEXINGTON AVENUE ASHLAND KY 41101 260791997 MEDICAL RESEARCH KY 501(C)(3) LINE 7 ASHLAND HOSPITAL CORPORATION 0 CHILD DEVELOPMENT CENTER CORPORATION 2201 LEXINGTON AVENUE ASHLAND KY 41101 010560598 DAYCARE KY 501(C)(3) LINE 10 ASHLAND HOSPITAL CORPORATION 0 KENTUCKY HEART INSTITUTE INC 2201 LEXINGTON AVENUE ASHLAND KY 41101 611255904 PHYSICIANS KY 501(C)(3) LINE 10 ASHLAND HOSPITAL CORPORATION 0 ROYAL BLUE HEALTH LLC 2201 LEXINGTON AVENUE ASHLAND KY 41101 862993817 HEALTHCARE KY 501(C)(3) LINE 12B, II N/A 0 KING'S DAUGHTERS HEALTH FOUNDATION INC 2201 LEXINGTON AVENUE ASHLAND KY 41101 611035701 FUNDRAISING KY 501(C)(3) LINE 12B, II N/A 0 ASHLAND MEDICAL PROPERTIES INC 2201 LEXINGTON AVE ASHLAND KY 41101 611079090 RENTALS KY N/A C 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 1 1