2020-07-14T12:55:16-05:00 2019-06-30 273858252 DEAN DORTON ALLEN FORD PLLC 250 W MAIN STR STE 1400 LEXINGTON KY 40507 990 2018-07-01 610945743 KENTUCKY MEDICAL SERVICES FOUNDATION INC KENT 8592577910 2333 ALUMNI PARK PLAZA NO 200 LEXINGTON KY 40517 JAY S GRIDER DO PHD MBA PRESIDENT 8592577910 2020-07-14 1 ALLISON C CARTER P01242412 8592552341 192.243.74.13 2020-07-14 09:42:26 ED P F6AB8AE3F08F4AF1164E223E0046F1F2ED5B5E8A FD7354DB22FB8D2AC589089E7FCD97818B14017D 2018 2020-09-22 18:59:49Z JAY S GRIDER DO PHD M 2333 ALUMNI PARK PLAZA NO 200 LEXINGTON KY 40517 382020599 0 X N/A X 1980 KY SUPPORTING THE UNIVERSITY OF KY SO IT MAY ACHIEVE ITS GOALS IN HEALTHCARE 28 2 238 2 0 0 0 0 338416155 363183395 548913 756423 20202833 18024580 359167901 381964398 1185904 1225894 0 0 9622975 8583814 0 0 0 346149908 380486150 356958787 390295858 2209114 -8331460 233895764 212550231 197505157 184491084 36390607 28059147 X SEE SCHEDULE O 0 0 360508727 1225894 381207975 KMSF COLLECTS FEES FROM PROVISION OF PATIENT SERVICES PROVIDED BY THE UNIVERSITY OF KENTUCKY COLLEGE OF MEDICINE. BY PERFORMING THESE DUTIES KMSF SUPPORTS THE HOSPITAL AND HELPS THEM TO FULFILL THEIR EXEMPT PURPOSE. COLLECTIONS, AFTER PAYMENT OF DIRECT EXPENSES, ARE REMITTED TO THE COLLEGE WHICH USES THE FUNDS IN THE AREAS OF TEACHING, RESEARCH AND SERVICE. 360508727 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 1 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 182 0 1 238 1 0 0 0 0 0 0 0 0 0 0 0 0 X 28 2 0 0 1 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X X KATERINA MOLINA 8592577910 2333 ALUMNI PARK PLAZA SUITE 200 LEXINGTON KY 40517 AFTAB CHISHTI DIRECTOR 1.00 X 0 246850 31148 CHESTER JENNINGS DIRECTOR 1.00 X 0 430000 52468 CRAIG COLLINS DIRECTOR 1.00 X 0 450835 45083 DAVID MOLITERNO DIRECTOR 1.00 X 0 728851 83948 DONNA GRIGSBY DIRECTOR 1.00 X 0 220000 27970 JAY GRIDER DIRECTOR 1.00 X 0 402822 47315 JEFFREY SELBY DIRECTOR 1.00 X 0 748500 80820 JOHN ROTH DIRECTOR 1.00 X 0 429670 54115 JOSEPH ZWISCHENBERGER DIRECTOR 1.00 X 0 820000 91468 LARRY GOLDSTEIN DIRECTOR 1.00 X 0 420200 47970 MARCUS RANDALL DIRECTOR 1.00 X 0 650000 74468 MARK NEWMAN DIRECTOR 1.00 X 0 1174920 138231 MARY ELIZABETH OATES DIRECTOR 1.00 X 0 610000 72148 PATRICK MCGRATH DIRECTOR 1.00 X 0 533030 59273 PAUL PEARSON DIRECTOR 1.00 X 0 555500 66698 PHILLIP CHANG DIRECTOR 1.00 X 0 487622 56610 PHILLIP TIBBS DIRECTOR 1.00 X 0 1043000 113768 RALEIGH JONES DIRECTOR 1.00 X 0 541895 60160 ROBERT DIPAOLA DIRECTOR 1.00 X 0 619612 73109 ROBERT GAISER DIRECTOR 1.00 X 0 554062 65148 ROBERTO CARDARELLI DIRECTOR 1.00 X 0 342500 40220 ROGER HUMPHRIES DIRECTOR 1.00 X 0 546285 51970 SCOTTIE DAY DIRECTOR 1.00 X 0 480300 56148 SETH HIMELHOCH DIRECTOR 1.00 X 0 445600 51586 STEPHEN STRUP DIRECTOR 1.00 X 0 551005 66249 SUSAN MCDOWELL DIRECTOR 1.00 X 0 412126 46970 TIMOTHY CAUDILL DIRECTOR 1.00 X 0 290000 40148 WENDY HANSEN DIRECTOR 1.00 X 0 545000 65648 CARRIE MEEKER EXECUTIVE DIRECTOR 40.00 X 266898 0 38541 KATERINA MOLINA DIRECTOR OF FINANCE & ACCO 40.00 X 161780 0 32774 HERMAN WALTERS DIRECTOR OF IT 40.00 X 152025 0 31834 BRENDA NICHOLS DIRECTOR OF HUMAN RESOURCES 40.00 X 138167 0 19954 SHELBY GORMAN DIRECTOR OF COMPLIANCE & CODING ED 40.00 X 137557 0 21486 COLETTE MINK DIRECTOR OF REVENUE CYCLE MGNT 40.00 X 132415 0 19293 988842 15280185 1924739 9 0 1 0 IVEY MECHANICAL COMPANY LLC PO BOX 610 KOSCIUSKO MS 39090 REPAIR & MAINTENANCE SERVICES 1116982 HARRODSBURG ANESTHESIA 425 SHAWNEE RUN ROAD HARRODSBURG KY 40330 PROFESSIONAL SERVICES 371390 TODD HARGET 6880 JACKS CREEK PIKE LEXINGTON KY 40515 CONTRACTOR SERVICES 366760 RIVER CITY ANESTHESIA 2804 SAGE WOOD DR NEWTOWN SQUARE PA 19073 PROFESSIONAL SERVICES 241279 STOLL KEENON OGDEN PLLC PO BOX 11969 LEXINGTON KY 40579 PROFESSIONAL LEGAL SERVICES 240194 9 CLINIC SERVICE FEES 561000 356783715 356783715 RENT FROM SUPPORTED ORGANIZATION 531120 6399680 6399680 363183395 803776 803776 132421 8848 123573 123573 123573 47353 -47353 -47353 -47353 HONORARIUM & OTHER MISC INCOME 900099 17901007 17901007 17901007 381964398 381207975 0 756423 1225894 1225894 305439 305439 5799235 5799235 1041360 1041360 556588 556588 881192 881192 419337 419337 68897 68897 39265 39265 2286112 2286112 1482375 1482375 3399961 3399961 13251815 13251815 255555 255555 UK PHYSICIANS' SALARIES 244356478 244356478 BAD DEBTS 50835145 50835145 PROFESSIONAL DEVELOPMEN 28322474 28322474 ACADEMIC ENRICHMENT 13775000 13775000 21993736 21993736 390295858 360508727 29787131 0 47146746 36607203 53329877 47318530 908459 782904 82518 583653 150308168 45652998 110733404 104655170 21694760 22602771 233895764 212550231 6175082 8495996 18933688 18175117 55439314 58437165 116957073 99382806 197505157 184491084 X 36390607 28059147 36390607 28059147 233895764 212550231 -8331460 0 X X 0 1 X 1 0 X X X 1 UNIVERSITY OF KENTUCKY 616001218 6 1 390295858 0 1 390295858 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 PART IV, SECTION A, LINE 2: THE UNIVERISTY OF KENTUCKY IS A GOVERNMENTAL ENTITY DESCRIBED IN 170(B)(1)(A)(V). FORM 990, SCHEDULE A, PART I KMSF HAS BEEN ASSIGNED THE RESPONSIBILITY TO BILL, COLLECT, AND ADMINISTER ALL CLINICAL INCOME GENERATED BY THE PHYSICIANS OF THE UNIVERSITY OF KENTUCKY COLLEGE OF MEDICINE, THUS PROVIDING A SERVICE TO UK. PART IV, SECTION B, LINE 1: PERSONS HOLDING CERTAIN POSITIONS WITHIN THE UNIVERSITY OF KENTUCKY COLLEGE OF MEDICINE SERVE AS EX OFFICIO VOTING DIRECTORS (THESE POSITIONS ARE THE DEAN AND CHAIR OF EACH CLINICAL DEPARTMENT); OTHER DIRECTORS ARE ELECTED BY THE FACULTY OF THE UK COLLEGE OF MEDICINE. 2066767 2066767 119993167 26763878 93229289 10427963 8872778 1555185 17820271 10016342 7803929 104655170 DUE TO UNIVERSITY OF KENTUCKY 36903015 DUE TO UNIVERSITY OF KENTUCKY MALPRACTICE FUND 22819902 DUE TO COLLEGE OF MEDICINE DEPARTMENTS 39090415 DUE TO THIRD PARTY PAYERS 569474 99382806 1 TUITION SUPPORT FOR DEPENDENTS OF UK FACULTY MEMBERS 112 1225894 PART I, LINE 2: KMSF REQUIRES TRANSCRIPTS AND PROOF OF ENROLLMENT EVERY SEMESTER TO MONITOR APPROPRIATE USE OF SCHOLARSHIP FUNDS. X 1 1 X X 0 0 0 0 0 0 0 0 0 AFTAB CHISHTI DIRECTOR 0 177648 0 43835 0 25367 0 20000 0 11148 0 277998 0 0 CHESTER JENNINGS DIRECTOR 0 364555 0 51600 0 13845 0 43000 0 9468 0 482468 0 0 CRAIG COLLINS DIRECTOR 0 362105 0 82025 0 6705 0 45083 0 0 0 495918 0 0 DAVID MOLITERNO DIRECTOR 0 630084 0 83720 0 15047 0 72800 0 11148 0 812799 0 0 DONNA GRIGSBY DIRECTOR 0 205659 0 10666 0 3675 0 22000 0 5970 0 247970 0 0 JAY GRIDER DIRECTOR 0 307883 0 86761 0 8178 0 36167 0 11148 0 450137 0 0 JEFFREY SELBY DIRECTOR 0 704345 0 41842 0 2313 0 74850 0 5970 0 829320 0 0 JOHN ROTH DIRECTOR 0 334783 0 92002 0 2885 0 42967 0 11148 0 483785 0 0 JOSEPH ZWISCHENBERGER DIRECTOR 0 715308 0 86100 0 18592 0 82000 0 9468 0 911468 0 0 LARRY GOLDSTEIN DIRECTOR 0 366392 0 46200 0 7608 0 42000 0 5970 0 468170 0 0 MARCUS RANDALL DIRECTOR 0 557206 0 87750 0 5044 0 65000 0 9468 0 724468 0 0 MARK NEWMAN DIRECTOR 0 793461 0 252146 0 129313 0 111492 0 26739 0 1313151 0 0 MARY ELIZABETH OATES DIRECTOR 0 522217 0 79300 0 8483 0 61000 0 11148 0 682148 0 0 PATRICK MCGRATH DIRECTOR 0 471369 0 46171 0 15490 0 53303 0 5970 0 592303 0 0 PAUL PEARSON DIRECTOR 0 473100 0 53200 0 29200 0 55550 0 11148 0 622198 0 0 PHILLIP CHANG DIRECTOR 0 418192 0 66113 0 3317 0 48762 0 7848 0 544232 0 0 PHILLIP TIBBS DIRECTOR 0 912898 0 117600 0 12502 0 104300 0 9468 0 1156768 0 0 RALEIGH JONES DIRECTOR 0 461136 0 72800 0 7959 0 54190 0 5970 0 602055 0 0 ROBERT DIPAOLA DIRECTOR 0 475869 0 119925 0 23818 0 61961 0 11148 0 692721 0 0 ROBERT GAISER DIRECTOR 0 466851 0 70253 0 16958 0 54000 0 11148 0 619210 0 0 ROBERTO CARDARELLI DIRECTOR 0 301353 0 39671 0 1476 0 34250 0 5970 0 382720 0 0 ROGER HUMPHRIES DIRECTOR 0 463949 0 62100 0 20236 0 46000 0 5970 0 598255 0 0 SCOTTIE DAY DIRECTOR 0 422533 0 56250 0 1517 0 45000 0 11148 0 536448 0 0 SETH HIMELHOCH DIRECTOR 0 386487 0 19350 0 39763 0 43000 0 8586 0 497186 0 0 STEPHEN STRUP DIRECTOR 0 470074 0 66125 0 14806 0 55101 0 11148 0 617254 0 0 SUSAN MCDOWELL DIRECTOR 0 354157 0 55350 0 2619 0 41000 0 5970 0 459096 0 0 TIMOTHY CAUDILL DIRECTOR 0 282990 0 1503 0 5507 0 29000 0 11148 0 330148 0 0 WENDY HANSEN DIRECTOR 0 469808 0 59950 0 15242 0 54500 0 11148 0 610648 0 0 CARRIE MEEKER EXECUTIVE DIRECTOR 254828 0 0 0 12070 0 24826 0 13715 0 305439 0 0 0 KATERINA MOLINA DIRECTOR OF FINANCE & ACCO 161780 0 0 0 0 0 0 0 32774 0 194554 0 0 0 HERMAN WALTERS DIRECTOR OF IT 152025 0 0 0 0 0 0 0 31834 0 183859 0 0 0 BRENDA NICHOLS DIRECTOR OF HUMAN RESOURCES 138167 0 0 0 0 0 0 0 19954 0 158121 0 0 0 SHELBY GORMAN DIRECTOR OF COMPLIANCE & CODING ED 137557 0 0 0 0 0 0 0 21486 0 159043 0 0 0 COLETTE MINK DIRECTOR OF REVENUE CYCLE MGNT 132415 0 0 0 0 0 0 0 19293 0 151708 0 0 0 A CLARK COUNTY KENTUCKY 616000993 2017-04-04 10000000 DEBT REFINANCE 0 0 0 B SCOTT COUNTY KENTUCKY 616000775 2017-04-21 9750000 DEBT REFINANCE 0 0 0 A 10000000 203524 9796476 2017 0 0 1 1 B 9750000 1005074 8744926 2017 0 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 A 0 0 1 0 1 0 0 0 1 B 0 0 1 0 1 0 0 0 1 A 1 B 1 ABIGAIL PEARSON CHILD OF BOARD MEMBER 23842 SCHOLARSHIP BENJAMIN MOLITERNO CHILD OF BOARD MEMBER 19918 SCHOLARSHIP BLAKE DIPAOLA CHILD OF BOARD MEMBER 6035 SCHOLARSHIP ELAINA GRUBER CHILD OF EXECUTIVE DIRECTOR 12070 SCHOLARSHIP EMAD CHISHTI CHILD OF BOARD MEMBER 12070 SCHOLARSHIP JONATHON HUMPHRIES CHILD OF BOARD MEMBER 6035 SCHOLARSHIP MADELINE HUMPHRIES CHILD OF BOARD MEMBER 12070 SCHOLARSHIP MALKA HIMELHOCH CHILD OF BOARD MEMBER 12070 SCHOLARSHIP NICHOLAS GRIDER CHILD OF BOARD MEMBER 17956 SCHOLARSHIP PAUL PEARSON CHILD OF BOARD MEMBER 5886 SCHOLARSHIP SYDNEY STRUP CHILD OF BOARD MEMBER 17956 SCHOLARSHIP SCHEDULE L, PART III GRANTS LISTED ON SCHEDULE L ARE SCHOLARSHIPS PROVIDED TO CHILDREN OF BOARD MEMBERS WHO ARE FACULTY MEMBERS AT THE UNIVERSITY OF KENTUCKY. THE DEPENDENTS OF ALL FULL-TIME FACULTY ARE ELIGIBLE FOR THESE SCHOLARSHIPS AND ELIGIBILITY AND DISTRIBUTION ARE SUBJECT TO THE REQUIREMENTS OF THE PROGRAM. BOARD MEMBERS DO NOT SPECIFICALLY SELECT RECIPIENTS. FORM 990, PART VI, SECTION A, LINE 4 LEADERSHIP STRUCTURE WAS CHANGED FROM AN EXECUTIVE DIRECTOR NON-PHYSICIAN LEADERSHIP MODEL TO A PRESIDENT/CEO PHYSICIAN LEADERSHIP MODEL. OTHER NOMINAL CHANGES: ELECT A PRESIDENT-ELECT FOUR MONTHS PRIOR TO THE END OF THE OUTGOING PRESIDENT'S TERM TO ALLOW FOR A TRANSITION OF DUTIES; CHANGED NAME OF NOMINATING & GOVERNANCE COMMITTEE TO JUST NOMINATING COMMITTEE (GOVERNANCE DUTIES HAVE TRANSFERRED TO KMSF EXECUTIVE COMMITTEE); NON-VOTING ADVISORY MEMBERS APPOINTED BY THE PRESIDENT ARE NOW CONSIDERED VOTING MEMBERS. FORM 990, PART VI, SECTION B, LINE 11B THE 990 TAX RETURN IS PREPARED BY AN INDEPENDENT CPA FIRM BASED ON THE INFORMATION OBTAINED FROM THE AUDIT AND INQUIRIES FROM MANAGEMENT. BEFORE THE RETURN IS FILED, A DRAFT OF THE INFORMATIONAL RETURN IS REVIEWED BY MANAGEMENT. THE BOARD WILL REVIEW THE 990 AT A MEETING SHORTLY AFTER FILING AND ANY NECESSARY CHANGES WILL BE MADE AT THAT TIME. FORM 990, PART VI, SECTION B, LINE 12C EXECUTIVE LEADERSHIP HAS IMPLEMENTED A POLICY THAT OFFICERS, DIRECTORS, AND KEY EMPLOYEES SHOULD ANNUALLY DISCLOSE CONFLICTS AND THE CONFLICT OF INTEREST POLICY IS CONSISTENTLY MONITORED AND ENFORCED. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION IS DELIBERATED BY THE BOARD IN A CLOSED DOOR MEETING. AS PART OF THEIR REVIEW THEY USE AAMC GROUP ON FACULTY PRACTICE BENCHMARKS FOR COMPARISON. FORM 990, PART VI, SECTION C, LINE 19 FORMS 990 AND 990T ARE POSTED ON THE KMSF.COM WEBSITE AND ARE ALSO AVAILABLE UPON REQUEST. FORM 1023 IS PROVIDED UPON REQUEST. FORM 990, PART XII, LINE 2C: THE AUDIT COMMITTEE ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED SINCE THE PRIOR YEAR. FORM 990, PART III, LINE 1 TO COORDINATE AND DEVELOP SUPERIOR PATIENT CARE IN A GROUP PRACTICE SETTING WITHIN THE ACADEMIC ENVIRONMENT OF THE MEDICAL CENTER OF THE UNIVERSITY OF KENTUCKY IN LEXINGTON, INCLUDING THE PROVISION OF FINANCIAL SUPPORT FOR THE MEDICAL CENTER'S TEACHING, RESEARCH AND SERVICE PROGRAMS AND FOR THE PERSONNEL AND EQUIPMENT NECESSARY FOR SUCH PROGRAMS, AND IN FURTHERANCE OF THIS GENERAL PURPOSE TO EXECUTE AND PERFORM A PUBLIC TRUST IN SUPPORTING, AIDING, AND ADVANCING THE STUDY AND INVESTIGATION OF HUMAN ILLNESSES AND INJURIES, AND THE CAUSES, PREVENTIONS, RELIEF AND CURE THEREOF, AND THE STUDY AND INVESTIGATION OF PROBLEMS OF HYGIENE AND HEALTH; TO ENCOURAGE, PROMOTE AND PERFORM MEDICAL, SURGICAL AND SCIENTIFIC LEARNING, SKILL, EDUCATION AND INVESTIGATION; TO PROMOTE MEDICAL, SURGICAL, AND SCIENTIFIC SERVICES; TO ATTRACT AND RETAIN HIGH QUALITY FACULTY TO TEACH, CONDUCT RESEARCH AND PROVIDE PATIENT CARE; TO PROVIDE SUPPORT TO ENABLE THE COLLEGE OF MEDICINE TO ACCOMPLISH ITS EDUCATIONAL, RESEARCH AND SERVICE GOALS; TO ASSIST PROGRAMS OF MEDICAL, SURGICAL AND SCIENTIFIC EDUCATION AND RESEARCH; TO CARRY ON SUCH PROGRAMS OF PUBLIC CHARITY AS MAY BE RELATED TO THE CARRYING OUT OF THE OTHER STATED PURPOSES OF THE CORPORATION, AND, SPECIFICALLY THE CHARITABLE PROGRAMS UTILIZING THE KNOWLEDGE AND SKILLS ACQUIRED BY THE CORPORATION THROUGH ITS ABOVE-DESCRIBED OPERATIONS FOR THE BENEFIT OF ALL PERSONS WHO MAY BE IN NEED THEREOF, REGARDLESS OF HIS OR HER ABILITY TO PAY. UNIVERSITY OF KENTUCKY 800 ROSE STREET LEXINGTON KY 40536 616001218 EDUCATIONAL DEVELOPMENT, HEALTHCARE KY 115 N/A N/A 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 1 0