2019-08-15T08:40:54-05:00 2018-09-30 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 221 W PHILADELPHIA STREET SUITE 200 YORK PA 17401 990 2017-10-01 611386016 ASHLAND NURSING HOME CORP ASHL 6063241414 2500 STATE ROUTE 5 ASHLAND KY 41102 AUTUMN MCFANN TREASURER 6063241414 2019-08-14 1 KERRI N BOGDA P00760402 7178467000 96.89.178.154 2019-08-14 09:50:52 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 D55C9BF7EA9CC92FF5CD8A3B56631CEAE08BA54E 2017 2019-02-21 02:37:17Z KINGSBROOK LIFECARE CENTER KRISTIE WHITLATCH 2201 LEXINGTON AVENUE ASHLAND KY 41101 13204360 0 X WWW.KINGSBROOK-LIFECARE.COM X 2002 KY TO PROVIDE QUALITY CARE TO PATIENTS NEEDING SHORT-TERM REHAB AND/OR LONG-TERM HEALTHCARE. 5 4 317 134 0 1450 0 0 13468023 13133940 13174 15051 72851 55369 13554048 13204360 0 0 0 0 8236746 7839552 0 0 0 4752069 4732165 12988815 12571717 565233 632643 11607503 11538602 801362 899818 10806141 10638784 OUR MISSION IS TO MEET THE NEEDS OF RESIDENTS AT VARIOUS LEVELS OF CARE INCLUDING SHORT-TERM REHAB AND LONG-TERM HEALTHCARE. 0 0 11135261 0 13133940 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. 11135261 1 0 0 1 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 3 0 317 1 1 1 0 0 0 0 0 0 0 0 0 X 5 4 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 KY X DAVID THOMAS DIRECTOR OF FINANCE 6063241414 2500 STATE ROUTE 5 ASHLAND KY 41102 KRISTIE WHITLATCH PRESIDENT 1.25 61.25 X X 0 830553 21898 SHERYL MAHANEY NON-VOTING SECRETARY 1.25 61.25 X X 0 415811 21756 AUTUMN MCFANN NON-VOTING TREASURER 1.25 61.25 X X 0 332527 21756 DAVID JONES DIRECTOR 0.25 5.75 X 0 0 0 STEPHEN ADDINGTON DIRECTOR 0.25 1.00 X 0 0 0 JOHN STEWART DIRECTOR 0.25 1.00 X 0 0 0 TOM BURNETTE DIRECTOR 0.25 1.25 X 0 0 0 0 1578891 65410 0 0 1 0 KENTUCKY MEDICAL LOGISTICS 425 22ND STREET ASHLAND KY 41101 TRANSPORTATION SERVICES 258681 ASHLAND HOSPITAL CORPORATION 2201 LEXINGTON AVENUE ASHLAND KY 41101 LAB & RADIOLOGY SERVICES 143530 2 NET PATIENT SERVICE REVENUE 623000 13133940 13133940 13133940 15051 15051 CAFETERIA/LAUNDRY SERVICES 722210 41042 41042 BEAUTY/BARBER SHOP 812900 9412 9412 VENDING COMMISSION/REBATES 812300 4427 4427 488 488 55369 13204360 13133940 0 70420 6413341 5579607 833734 772539 672109 100430 653672 568695 84977 30000 26100 3900 100000 100000 8170 7108 1062 2426 2111 315 532359 463153 69206 66339 57715 8624 37847 32927 4920 46624 40563 6061 501989 436730 65259 9236 8036 1200 390 339 51 436202 379496 56706 348778 303437 45341 SUPPLIES 1061180 923226 137954 PHARMACY 575864 575864 PROVIDER TAX 454556 454556 BAD DEBT EXPENSE 356283 356283 163922 147206 16716 12571717 11135261 1436456 0 1113738 629687 1557221 2021814 64091 74993 212874 236162 17742252 10987904 6837981 6754348 1821598 1821598 11607503 11538602 633169 725655 168193 174163 801362 899818 X 10806141 10638784 10806141 10638784 11607503 11538602 X 632643 -800000 X 0 1 X 1 0 X 15486664 15395466 14903974 13468023 13133940 72388067 15486664 15395466 14903974 13468023 13133940 72388067 0 0 0 72388067 5171 7792 10468 13174 15051 51656 5171 7792 10468 13174 15051 51656 97700 100867 94227 72851 55369 421014 15589535 15504125 15008669 13554048 13204360 72860737 0.99350 0.99320 0.00070 0.00050 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: CAFETERIA/LAUNDRY - 2013 AMOUNT: $ 58,102. 2014 AMOUNT: $ 62,671. 2015 AMOUNT: $ 63,124. 2016 AMOUNT: $ 54,285. 2017 AMOUNT: $ 41,042. BEAUTY/BARBER - 2013 AMOUNT: $ 31,447. 2014 AMOUNT: $ 31,109. 2015 AMOUNT: $ 26,872. 2016 AMOUNT: $ 12,195. 2017 AMOUNT: $ 9,412. VENDING COMMISSION/REBATE - 2013 AMOUNT: $ 2,964. 2014 AMOUNT: $ 3,060. 2015 AMOUNT: $ 3,645. 2016 AMOUNT: $ 5,727. 2017 AMOUNT: $ 4,427. OTHER - 2013 AMOUNT: $ 5,187. 2014 AMOUNT: $ 4,027. 2015 AMOUNT: $ 586. 2016 AMOUNT: $ 644. 2017 AMOUNT: $ 488. 0 0 0 0 0 0 0 0 1 2426 2426 0 PART II-B, LINE 1: A PORTION OF DUES PAID TO THE FOLLOWING ARE ATTRIBUTABLE TO LOBBYING: - KY ASSOCIATION OF HEALTH CARE FACILITIES $2,227 - THE AMERICAN HEALTHCARE SERVICES ASSOCIATION $199 348396 348396 13552507 8024918 5527589 3044683 2391138 653545 796666 571848 224818 6754348 NURSING HOME BED LICENSES 1819300 GOODWILL - PHARMACY 2298 1821598 DUE TO AFFILIATES 174163 174163 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. 0 1 0 0 0 0 0 0 0 KRISTIE WHITLATCH PRESIDENT 0 602774 0 90554 0 137225 0 5400 0 16498 0 852451 0 115099 SHERYL MAHANEY NON-VOTING SECRETARY 0 281378 0 42345 0 92088 0 5400 0 16356 0 437567 0 90156 AUTUMN MCFANN NON-VOTING TREASURER 0 284978 0 42885 0 4664 0 5400 0 16356 0 354283 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, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS: SHERYL MAHANEY - $90,156 KRISTIE WHITLATCH - $115,099 THERE WERE NO SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN CONTRIBUTIONS/DEFERRALS IN 2017. THE CEO AND VICE PRESIDENTS ARE ELIGIBLE TO RECEIVE DISCRETIONARY INCENTIVES BASED ON CERTAIN METRICS (QUALITY MEASURES, INDIVIDUAL GOALS, ETC.). THESE AWARDS ARE DETERMINED BY THE BOARD AND VESTED OVER A 5-10 YEAR PERIOD IF THE INDIVIDUAL REMAINS WITH THE ORGANIZATION. 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. 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 EFFECTIVE JUNE 2017, AHC EXECUTIVE MEMBERS MADE THE DECISION TO FOLD THE ANHC BOARD INTO THE MAIN BOARD OF TRUSTEES AND THAT THE BUSINESS OF ANHC BE MANAGED AS AN 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 IN DETAIL BY THE CFO AND CONTROLLER. AFTER THIS REVIEW, BUT BEFORE IT IS FILED WITH THE IRS,THE FINAL 990 WILL BE PROVIDED TO THE FULL BOARD OF DIRECTORS USING BOARD EFFECTS SOFTWARE. AN E-MAIL WITH A LINK TO THE POSTING WILL BE SENT TO EACH BOARD MEMBER ONCE THE REPORT HAS BEEN POSTED. 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 KINGSBROOK'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 KING'S DAUGHTERS HEALTH SYSTEM (KDHS) ENGAGED SULLIVAN COTTER AND ASSOCIATES, INC., A LEADING INDEPENDENT COMPENSATION CONSULTING COMPANY SPECIALIZING IN EXECUTIVE, EMPLOYEE AND PHYSICIAN COMPENSATION AND BENEFITS FOR THE HEALTH CARE AND NOT-FOR-PROFIT INDUSTRY, TO ASSIST IN DETERMINING COMPENSATION OF THE CEO, VICE PRESIDENTS, AND CHIEF MEDICAL OFFICERS. SULLIVAN COTTER'S MOST RECENT EXECUTIVE COMPENSATION REVIEW WAS PERFORMED IN 2016. SINCE THAT TIME, NO SIGNIFICANT ADJUSTMENTS HAVE BEEN MADE TO EXECUTIVE COMPENSATION. THE PRINCIPLE OBJECTIVE OF THIS STUDY WAS TO ASSEMBLE A DETAILED PROFILE OF THE CURRENT COMPENSATION LEVELS AVAILABLE TO EXECUTIVES MANAGING SIMILAR TASKS AND RESPONSIBILITIES AS MEMBERS OF THE KDHS EXECUTIVE TEAM. MOREOVER, THE OBJECTIVE WAS TO COMPILE MARKET DATA FOR EACH POSITION THAT WAS REFLECTIVE OF THE PAY LEVELS OFFERED BY INDEPENDENT, NOT-FOR-PROFIT HEALTH CARE ORGANIZATIONS OF COMPARABLE SIZE WITH OPERATIONS IN THE UNITED STATES. THE SULLIVAN COTTER DATA COUPLED WITH THE PERFORMANCE OF THE ORGANIZATION AS WELL AS THE PERSONAL PERFORMANCE OF EACH EXECUTIVE IS THE BASIS FOR KDHS'S HUMAN RESOURCE & COMPENSATION COMMITTEE'S REVIEW AND RECOMMENDATIONS, AND THE BOARD'S REVIEW AND APPROVAL OF COMPENSATION INCREASES. THE PROCESS INCLUDES A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THIS PROCESS WAS USED TO DETERMINE COMPENSATION FOR THE FOLLOWING POSITIONS: - PRESIDENT/CEO - VP, CHIEF COMPLIANCE OFFICER - VP, CHIEF FINANCIAL OFFICER - VP, CHIEF LEGAL & REGULATORY OFFICER/GENERAL COUNSEL - CHIEF MEDICAL OFFICERS - VP, PEOPLE SERVICES - VP, PATIENT SERVICES/CHIEF NURSING OFFICER - VP, CHIEF OPERATING OFFICER 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 XI, LINE 9: TRANSFER TO AFFILIATE -800,000. ASHLAND HOSPITAL CORPORATION 2201 LEXINGTON AVENUE ASHLAND KY 41101 610444716 HEALTHCARE KY 501(C)(3) LINE 3 KING'S DAUGHTERS HEALTH SYSTEM 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 KING'S DAUGHTERS HEALTH SYSTEM 0 KENTUCKY HEART FOUNDATION INC 2201 LEXINGTON AVENUE ASHLAND KY 41101 260791997 MEDICAL RESEARCH KY 501(C)(3) LINE 7 ASHLAND HOSPITAL CORPORATION 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 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 ASHLAND MEDICAL PROPERTIES INC 2201 LEXINGTON AVE ASHLAND KY 41101 611079090 RENTALS KY N/A C 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1