2023-08-14T19:48:19-05:00 2022-09-30 390859910 BAKER TILLY US LLP 1570 FRUITVILLE PIKE SUITE 400 LANCASTER PA 17601 990 2021-10-01 611386016 ASHLAND NURSING HOME CORP ASHL 6063241414 2500 STATE ROUTE 5 ASHLAND KY 41102 AUTUMN MCFANN TREASURER 6063241414 2023-08-14 1 AUTUMN MCFANN 999009999 KERRI N BOGDA CPA P00760402 7177404863 2023-08-14 X 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z KINGSBROOK LIFECARE CENTER SARA MARKS 2201 LEXINGTON AVENUE ASHLAND KY 41101 13109866 0 X WWW.KINGSBROOK-LIFECARE.COM X 2002 KY TO PROVIDE QUALITY CARE TO PATIENTS NEEDING SHORT-TERM REHAB AND/OR LONG-TERM HEALTHCARE. 8 8 294 8 0 0 222184 328765 12951594 12688630 -5625 2569 55329 89902 13223482 13109866 0 0 0 0 7980311 8401404 0 0 0 6493751 6016357 14474062 14417761 -1250580 -1307895 11060825 10815927 698103 1761100 10362722 9054827 OUR MISSION IS TO MEET THE NEEDS OF RESIDENTS AT VARIOUS LEVELS OF CARE INCLUDING SHORT-TERM REHAB AND LONG-TERM HEALTHCARE. 0 0 12295760 12688630 KINGSBROOK PROVIDES QUALITY CARE TO PATIENTS, MEETING THE NEEDS AND DESIRES OF RESIDENTS AT VARIOUS LEVELS OF CARE, INCLUDING SHORT-TERM AND LONG-TERM CARE. KINGSBROOK IS A 137-BED NURSING FACILITY WHICH PROVIDES SKILLED NURSING SERVICES AND REHABILITATION THERAPY TO RESIDENTS DESIRING TO RETURN HOME FROM AN ACUTE CARE HOSPITAL STAY. KINGSBROOK ALSO PROVIDES NURSING SERVICES AND CARE FOR RESIDENTS ON A LONG-TERM BASIS. 12295760 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 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 0 0 294 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 8 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 KRISTIE WHITLATCH NON-VOTING PRESIDENT 1.25 59.50 X X 0 2269672 2437 DAVID JONES BOARD CHAIRMAN 0.25 6.25 X X 0 0 0 MARK NEWMAN BOARD VICE CHAIR 0.25 5.75 X X 0 0 0 STEPHEN ADDINGTON DIRECTOR 0.25 2.50 X 0 0 0 MARK BIRDWHISTELL DIRECTOR 0.25 2.25 X 0 0 0 TOM BURNETTE DIRECTOR 0.25 2.75 X 0 0 0 CRAIG COLLINS DIRECTOR 0.25 2.25 X 0 0 0 ERIC MONDAY DIRECTOR 0.25 2.25 X 0 0 0 JOHN STEWART DIRECTOR 0.25 2.75 X 0 0 0 AUTUMN MCFANN NON-VOTING TREASURER 1.25 59.50 X 0 641478 79681 SHERYL MAHANEY NON-VOTING SECRETARY 1.25 59.50 X 0 681233 32931 JANE STRADER MD MEDICAL DIRECTOR 20.00 40.00 X 0 397373 29209 SARA MARKS VP/COO 1.25 59.00 X 0 652411 90218 JANE BLANKENSHIP EXECUTIVE DIRECTOR 40.00 10.00 X 0 170078 26071 0 4812245 260547 0 0 1 0 0 314210 14555 328765 NET PATIENT SERVICE REVENUE 623000 12688630 12688630 12688630 2569 2569 MEALS ON WHEELS 722513 40251 40251 CAFETERIA/LAUNDRY SERVICES 722513 26322 26322 BEAUTY/BARBER SHOP 812900 7511 7511 15818 15818 89902 13109866 12688630 0 92471 7142947 6214364 928583 729224 634425 94799 529233 460433 68800 154059 154059 24022 24022 1307832 1137814 170018 3598 3130 468 61210 53253 7957 454832 395704 59128 3531 3072 459 431475 375383 56092 379375 379375 SUPPLIES 1343711 1169029 174682 BAD DEBT EXPENSE 655450 655450 PHARMACY 578106 578106 PROVIDER TAX 406991 406991 212165 184584 27581 14417761 12295760 2122001 0 445085 818259 2524775 1978333 178674 108269 8496 11292 16127203 10049027 6082197 6078176 1821598 1821598 11060825 10815927 588660 587580 109443 1173520 698103 1761100 X 10362722 9054827 10362722 9054827 11060825 10815927 -1307895 0 X 0 1 X 1 1 1 X 866812 222184 328765 1417761 13133940 12718593 12161069 12951594 12688630 63653826 13133940 12718593 13027881 13173778 13017395 65071587 0 0 0 65071587 15051 13036 5954 988 2569 37598 15051 13036 5954 988 2569 37598 55369 62977 99260 55329 89902 362837 13204360 12794606 13133095 13230095 13109866 65472022 0.99390 0.99400 0.00060 0.00070 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: CAFETERIA/LAUNDRY - 2017 AMOUNT: $ 41,042. 2018 AMOUNT: $ 41,817. 2019 AMOUNT: $ 53,667. 2020 AMOUNT: $ 44,246. 2021 AMOUNT: $ 26,322. BEAUTY/BARBER - 2017 AMOUNT: $ 9,412. 2018 AMOUNT: $ 17,100. 2019 AMOUNT: $ 7,575. 2020 AMOUNT: $ 6,515. 2021 AMOUNT: $ 7,511. VENDING COMMISSION/REBATE - 2017 AMOUNT: $ 4,427. 2018 AMOUNT: $ 3,856. 2019 AMOUNT: $ 4,237. 2020 AMOUNT: $ 3,393. OTHER INCOME - 2017 AMOUNT: $ 488. 2018 AMOUNT: $ 204. 2019 AMOUNT: $ 57. 2020 AMOUNT: $ 1,175. 2021 AMOUNT: $ 15,818. EMPLOYEE RETENTION CREDIT - 2019 AMOUNT: $ 33,724. MEALS ON WHEELS - 2021 AMOUNT: $ 40,251. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 348396 348396 12696692 7835389 4861303 2257468 1554719 702749 824647 658919 165728 6078176 NURSING HOME BED LICENSES 1819300 GOODWILL - PHARMACY 2298 1821598 DUE TO AFFILIATES 1173520 1173520 X PART X, LINE 2: THE MEDICAL CENTER, KHF, KBNH, CDC, KHI, KDMT, KDMS, KDHF, AND KDOH HAVE BEEN RECOGNIZED BY THE IRS AS SECTION 501(C)(3) CHARITABLE ORGANIZATIONS. SECTION 501(C)(3) ORGANIZATIONS ARE EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME. THESE ORGANIZATIONS DO NOT ENGAGE IN SIGNIFICANT UNRELATED ACTIVITIES AND THEREFORE NO TAX IS RECORDED. X 0 1 1 1 0 0 0 0 0 1 0 KRISTIE WHITLATCH NON-VOTING PRESIDENT 0 201814 0 0 0 2067858 0 0 0 2437 0 2272109 0 169891 SARA MARKS VP/COO 0 395578 0 173348 0 83485 0 63050 0 27168 0 742629 0 50000 AUTUMN MCFANN NON-VOTING TREASURER 0 434390 0 138000 0 69088 0 63050 0 16631 0 721159 0 50000 SHERYL MAHANEY NON-VOTING SECRETARY 0 365660 0 182037 0 133536 0 16300 0 16631 0 714164 0 82011 JANE STRADER MD MEDICAL DIRECTOR 0 396869 0 0 0 504 0 13050 0 16159 0 426582 0 0 JANE BLANKENSHIP EXECUTIVE DIRECTOR 0 153041 0 16358 0 679 0 7767 0 18304 0 196149 0 0 PART I, LINE 1A GROSS-UP PAYMENTS: SHERYL MAHANEY $31,037; SARA MARKS $19,848 FROM AHC. NO GROSS-UP PAYMENTS WERE MADE BY ANHC. PART I, LINE 1B THE GROSS UPS ARE APPROVED BY THE PRESIDENT/CEO. 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 KRISTIE WHITLATCH (PRESIDENT/CEO) RECEIVED A CHANGE-OF-CONTROL PAYMENT OF $2,066,538 FROM AHC. NO SEVERANCE OR CHANGE OF CONTROL PAYMENT WAS MADE BY ANHC. 4 EMPLOYEES RECEIVED SUPPLEMENTAL RETIREMENT PLAN (SERP) PAYMENTS: KRISTIE WHITLATCH $66,075 AUTUMN MCFANN $18,248 SHERYL MAHANEY $16,876 SARA MARKS $12,377. 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. 4 EMPLOYEES RECEIVED 457(F) EXECUTIVE RETENTION PLAN PAYOUTS: KRISTIE WHITLATCH $169,891 SHERYL MAHANEY $82,011 AUTUMN MCFANN $50,000 SARA MARKS $50,000 ALL OF THESE PAYMENTS WERE MADE BY AHC. 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 VI, SECTION A, LINE 6 ASHLAND HOSPITAL CORPORATION (AHC) IS THE SOLE CORPORATE MEMBER OF ASHLAND NURSING HOME CORPORATION (ANHC). 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 ANHC BOARD IS FOLDED INTO THE MAIN BOARD OF TRUSTEES OF AHC'S PARENT CORPORATION. THE BUSINESS OF ANHC IS IS MANAGED AS AND AGENDA ITEM BY THE FULL BOARD INDEPENDENTLY OR THROUGH ITS COMMITTEE STRUCTURE. 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 ANY EMPLOYEE, MANAGER, OR OFFICER WHO REGULARLY INFLUENCES OR MAKES DECISIONS INVOLVING THE EXPENDITURE OF FACILITY FUNDS SHALL SIGN A CONFLICT OF INTEREST STATEMENT. THE FORM SHALL BE REVIEWED YEARLY AND SHALL BE FILED IN THE HUMAN RESOURCES OFFICE. WHEN AN EMPLOYEE HAS REPORTED A POTENTIAL OR ACTUAL CONFLICT OF INTEREST TO THE IMMEDIATE SUPERVISOR, THE RESPONSIBLE MANAGER AND THE ADMINISTRATOR SHALL BE NOTIFIED OF ALL FACTS PERTAINING TO ANY POTENTIAL TRANSACTIONS. IF IT IS DETERMINED THAT A CONFLICT DOES EXIST, THEN THE EMPLOYEES SHALL BE REMOVED FROM ANY PART OF THE DECISION-MAKING PROCESS, AND SHALL HAVE NO ROLE IN THE INSTANCE WHERE THE CONFLICT OF INTEREST EXISTS. THE EMPLOYEE'S IMMEDIATE SUPERVISOR SHALL ASSUME OR ASSIGN THE AUTHORITY TO ACT ON BEHALF OF THE EMPLOYEE IN ALL ACTIONS INVOLVING THE AREA OF CONFLICT. FAILURE TO REPORT CONFLICTS OF INTEREST IS A DIRECT VIOLATION OF ANHC'S POLICY AND WILL RESULT IN DISCIPLINARY ACTION. WHEN A MANAGER OF THE FACILITY REPORTS A POTENTIAL CONFLICT, THE MANAGER SHALL REMOVE HIMSELF/HERSELF FROM ANY DISCUSSION OR VOTING REGARDING THE POTENTIAL CONFLICT. 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 SEDONA PARTNERS AS WELL AS REVIEW OF LOCAL AND REGIONAL SALARY INFORMATION PROVIDED THROUGH A MARSHALL UNIVERSITY SURVEY. MERCER PERIODICALLY PERFORMS A REVIEW OF EXECUTIVE COMPENSATION AND BENEFITS. 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. SULLIVAN COTTER, AN INDEPENDENT COMPENSATION EXPERT, REVIEWS ALL PHYSICIAN COMPENSATION AND BENEFITS 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. ASHLAND HOSPITAL CORPORATION 2201 LEXINGTON AVENUE ASHLAND KY 41101 610444716 HEALTHCARE KY 501(C)(3) LINE 3 ROYAL BLUE HEALTH LLC 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 KING'S DAUGHTERS MEDICAL SPECIALTIES INC 2201 LEXINGTON AVENUE ASHLAND KY 41101 264183569 PHYSICIANS 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 KING'S DAUGHTERS HEALTH SYSTEM 0 KING'S DAUGHTERS HEALTH FOUNDATION INC 2201 LEXINGTON AVENUE ASHLAND KY 41101 611035701 FUNDRAISING KY 501(C)(3) LINE 12B, II ASHLAND HOSPITAL CORPORATION 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 0 0 0 0 0 1 0 0 1 1