2018-08-14T15:01:56-05:00 2017-09-30 390859910 Baker Tilly Virchow Krause LLP 1650 Market Street Suite 4500 Philadelphia PA 191037341 990 2016-10-01 611386016 Ashland Nursing Home Corp ASHL 6063241414 2500 State Route 5 Ashland KY 41102 Autumn McFann Treasurer 6063241414 2018-08-14 1 Julius C Green CPA P00350393 2159720701 2016 2022-09-23 18:48:47Z kingsbrook lifecare center Kristie Whitlatch 2201 Lexington Avenue Ashland KY 41101 13554048 0 X www.kingsbrook-lifecare.com X 2002 KY TO PROVIDE QUALITY CARE TO PATIENTS NEEDING SHORT-TERM REHAB AND/OR LONG-TERM HEALTHCARE. 4 3 340 103 0 0 0 0 14903974 13468023 10468 13174 94227 72851 15008669 13554048 0 0 0 0 8690103 8236746 0 0 0 5148098 4752069 13838201 12988815 1170468 565233 12750701 11607503 909793 801362 11840908 10806141 Our mission is to meet the needs of residents at various levels of care including short-term rehab and long-term healthcare. 0 0 11495220 0 13468023 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. 11495220 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 1 340 1 0 0 0 0 0 0 0 0 0 0 X 4 3 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 688020 11186 sheryl mahaney secretary (non-voting) 1.25 61.25 X X 0 422753 9111 AUTUMN MCFANN TREASURER (non-voting) 1.25 61.25 X X 0 283114 14709 EB LOWMAN II DIRECTOR 0.25 X 0 0 0 DAVID JONES DIRECTOR 0.25 5.75 X 0 0 0 WILLIE MCCULLOUGH DIRECTOR 0.25 X 0 0 0 REV JIM NICHOLS DIRECTOR (UNTIL 12/31/16) 0.25 X 0 0 0 0 1393887 35006 0 0 1 0 Kentucky Medical Logistics 425 22nd Street Ashland KY 41101 Transportation Services 151700 ASHLAND HOSPITAL CORPORATION 2201 LEXINGTON AVENUE ASHLAND KY 41101 LAB & RADIOLOGY SERVICES 144373 River Cities Roofing 103 TOP STREET SOUTH POINT OH 45680 CONSTRUCTION 129000 Stericycle 4010 Commercial Avenue Northbrook IL 60062 Waste Management Services 116992 4 NET PATIENT SERVICE REVENUE 623000 13468023 13468023 13468023 13174 13174 CAFETERIA/Laundry Services 722210 54285 54285 BEAUTY/BARBER SHOP 812900 12195 12195 Vending Commission/Rebates 812300 5727 5727 644 644 72851 13554048 13468023 0 86025 6802298 5917999 884299 734115 638694 95421 700333 609290 91043 30000 26100 3900 9891 8605 1286 2651 2306 345 493838 429639 64199 49415 42991 6424 35172 30600 4572 49285 42878 6407 552722 480868 71854 10233 8902 1331 550647 479063 71584 294344 256079 38265 supplies 1045275 909389 135886 pharmacy 645503 645503 provider tax 438648 438648 BAD DEBT EXPENSE 370676 370676 173769 156990 16779 12988815 11495220 1493595 0 1678176 1113738 1931348 1557221 62706 64091 178505 212874 17389682 10551701 7078368 6837981 1821598 1821598 12750701 11607503 735206 633169 174587 168193 909793 801362 X 11840908 10806141 11840908 10806141 12750701 11607503 X 565233 -1600000 X 0 1 X 1 0 X 15020791 15486664 15395466 14903974 13468023 74274918 15020791 15486664 15395466 14903974 13468023 74274918 0 0 0 74274918 3806 5171 7792 10468 13174 40411 3806 5171 7792 10468 13174 40411 101520 97700 100867 94227 72851 467165 15126117 15589535 15504125 15008669 13554048 74782494 0.99320 0.99280 0.00050 0.00040 X Schedule A, Part III, Line 12, Explanation of Other Income: CAFETERIA/LAUNDRY - 2012 Amount: $ 55,460. 2013 Amount: $ 58,102. 2014 Amount: $ 62,671. 2015 Amount: $ 63,124. 2016 Amount: $ 54,285. BEAUTY/BARBER - 2012 Amount: $ 29,682. 2013 Amount: $ 31,447. 2014 Amount: $ 31,109. 2015 Amount: $ 26,872. 2016 Amount: $ 12,195. VENDING COMMISSION/REBATE - 2012 Amount: $ 1,892. 2013 Amount: $ 2,964. 2014 Amount: $ 3,060. 2015 Amount: $ 3,645. 2016 Amount: $ 5,727. OTHER - 2012 Amount: $ 14,486. 2013 Amount: $ 5,187. 2014 Amount: $ 4,027. 2015 Amount: $ 586. 2016 Amount: $ 644. 0 0 0 0 0 0 0 0 1 2651 2651 0 Part II-B, Line 1: A portion of dues paid to the following ARE ATTRIBUTABLE TO LOBBYING: KY Association of Health Care Facilities $2,433 The American Healthcare Services Association $218 348396 348396 13498189 7754733 5743456 2748731 2247666 501065 794366 549302 245064 6837981 NURSING HOME BED LICENSES 1819300 GOODWILL - PHARMACY 2298 1821598 DUE TO AFFILIATES 168193 168193 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 500034 0 68054 0 119932 0 3975 0 7211 0 699206 0 117310 sheryl mahaney secretary (non-voting) 0 289847 0 42345 0 90561 0 3975 0 5136 0 431864 0 88629 AUTUMN MCFANN TREASURER (non-voting) 0 226377 0 48871 0 7866 0 3975 0 10734 0 297823 0 0 Part I, Line 3 COMPENSATION FOR THE CEO IS DETERMINED BY KING'S DAUGHTERS MEDICAL CENTER (RELATED ORGANIZATION) USING THE FOLLOWING METHODS: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY/STUDY, AND APPROVAL BY THE BOARD/COMPENSATION COMMITTEE. Part I, Line 4b SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS: SHERYL MAHANEY - $88,629 KRISTIE WHITLATCH - $117,310 THERE WERE NO SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN CONTRIBUTIONS/DEFERRALS IN 2016. 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 is the sole corporate member of Ashland Nursing Home Corporation. ASHLAND HOSPITAL CORPORATION, a 501(c)(3) entity, is the parent organization of an integrated healthcare delivery system. Form 990, Part VI, Section A, line 7a ASHLAND HOSPITAL CORPORATION elects the board members of Ashland Nursing Home Corporation on an annual basis or until a successor is named. Form 990, Part VI, Section B, line 11b THE FORM 990 IS REVIEWED BY THE CONTROLLER AND THE CFO OF ASHLAND HOSPITAL CORPORATION. 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 At the direction of the Human Resources & Compensation Committee of the Board of King's Daughters Health System (KDHS), 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. This is an annual process and sullivan cotter's most recent executive compensation review was performed in 2016. 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, Executive Director King's Daughters Integrated Physicians - VP, Patient Services/Chief Nursing 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: GIFT TO RELATED ORGANIZATION -1,600,000. 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 12c, III-FI 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