2017-05-15T14:58:46-05:00 2016-06-30 273858252 DEAN DORTON ALLEN FORD PLLC 106 W VINE STREET SUITE 600 LEXINGTON KY 40507 990 2015-07-01 610945743 KENTUCKY MEDICAL SERVICES FOUNDATION INC KENT 8592577910 2333 ALUMNI PARK PLAZA NO 200 LEXINGTON KY 40517 CARRIE A CASSIS EXECUTIVE DIRECTOR 8592577910 2017-05-15 1 LEIGH MCKEE P00169845 8592552341 2015 2021-01-29 14:40:06Z CARRIE A CASSIS 2333 ALUMNI PARK PLAZA NO 200 LEXINGTON KY 40517 326452220 0 X N/A X 1980 KY SUPPORTING THE UNIVERSITY OF KY SO IT MAY ACHIEVE ITS GOALS IN HEALTHCARE 26 26 190 0 0 0 0 0 306122685 315031569 140530 224162 395580 11182538 306658795 326438269 1173159 1104261 0 0 4471194 7324382 0 0 0 290023941 315422809 295668294 323851452 10990501 2586817 193661260 194926266 160151814 158830003 33509446 36096263 SEE SCHEDULE O 0 0 290331132 1104261 326148236 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. 290331132 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 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 207 0 1 190 1 0 0 0 0 0 0 0 0 0 0 X 26 26 0 0 0 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 ANDREW PEARSON MD DIRECTOR 1.00 X 0 560518 65760 BERNARD BOULANGER MD DIRECTOR 1.00 X 0 559736 61014 CARMELL WALLACE MD DIRECTOR 1.00 X 0 380910 47796 DARRELL JENNINGS MD DIRECTOR 1.00 X 0 431748 53095 DARREN JOHNSON MD DIRECTOR 1.00 X 0 748340 78145 DAVID MOLITERNO MD DIRECTOR 1.00 X 0 802412 86652 EDWIN BOWE MD DIRECTOR 1.00 X 0 647070 70674 ELIZABETH OATES MD DIRECTOR 1.00 X 0 644418 73905 FREDERICK C DE BEER MD DIRECTOR 1.00 X 0 757864 108961 JOSEPH ZWISCHENBERGER MD DIRECTOR 1.00 X 0 874240 98461 KEVIN PEARCE MD DIRECTOR 1.00 X 0 328950 43024 LARRY CARY MD DIRECTOR 1.00 X 0 233307 26191 LARRY GOLDSTEIN MD DIRECTOR 1.00 X 0 247310 29542 LON HAYS MD DIRECTOR 1.00 X 0 359480 41475 LOUIS BEZOLD DIRECTOR 1.00 X 0 304374 39769 MARC RANDALL MD DIRECTOR 1.00 X 0 758666 75609 MICHAEL KARPF MD DIRECTOR 1.00 X 0 2210542 1401031 MURRY CLARK DIRECTOR 1.00 X 0 594593 90685 PATRICK MCGRATH MD DIRECTOR 1.00 X 0 552093 57525 PHILIP TIBBS MD DIRECTOR 1.00 X 0 1185954 120820 RALEIGH JONES MD DIRECTOR 1.00 X 0 527862 57475 ROGER HUMPHRIES MD DIRECTOR 1.00 X 0 492870 51358 SCOTT STEVENS MD DIRECTOR 1.00 X 0 371055 47074 SHAWN CAUDILL MD DIRECTOR 1.00 X 0 291346 37791 SHEILA SANDERS MD DIRECTOR 1.00 X 0 121282 17807 STEPHEN STRUP MD DIRECTOR 1.00 X 0 586032 62902 SUSAN MCDOWELL DO DIRECTOR 1.00 X 0 410830 44314 WENDY HANSEN MD DIRECTOR 1.00 X 0 576621 66867 MYRA TOBIN DIRECTOR 1.00 X 0 0 0 ROBERT DIPAOLA DIRECTOR 1.00 X 0 0 0 CRAIG COLLINS DIRECTOR 1.00 X 0 279055 29975 MOTTI EDELSTEIN DIRECTOR 1.00 X 0 325464 43038 CARRIE A CASSIS EXECUTIVE DIRECTOR 40.00 X 79615 0 7615 PEGGY SUSAN HALCOMB DIRECTOR OF BILLING OPERAT 40.00 X 221023 0 21721 JAMES M TILLETT DIRECTOR OF INFORMATION TE 40.00 X 179325 0 17905 KATERINA MOLINA DIRECTOR OF FINANCE & ACCOUNTING 40.00 X 152760 0 15248 JUDY B BENSON INSURANCE FOLLOW-UP MANAGE 40.00 X 120109 0 11983 SHELBY GORMAN DIRECTOR OF COMPLIANCE 40.00 X 119335 0 11934 872167 17164942 3215141 13 0 1 0 DELOITTE CONSULTING LP PO BOX 844717 DALLAS TX 75284 CONSULTING SERVICES 7665823 APPALACHIAN HEART CENTER 200 MEDICAL CENTER DR HAZARD KY 41701 PHYSICIAN SERVICES 2318269 SHEPPARD MULLIN RICHTER & HAMPTON 333 SOUTH HOPE ST 43RD FL LOS ANGELES CA 90071 PROFESSIONAL SERVICES 703218 HARRODSBURG ANESTHESIA 425 SHAWNEE RUN RD HARRODSBURG KY 40330 CRNA SERVICES 361702 DIVURGENT LLC 4445 COR LANE STE 228 VIRGINIA BEACH VA 23462 IT CONSULTING 283711 15 CLINIC SERVICE FEES 561000 310328908 310328908 RENT FROM SUPPORTED ORGANIZATION 531120 4702661 4702661 315031569 157279 157279 79822 13951 65871 65871 65871 66883 0 66883 66883 66883 HONORARIUM & OTHER MISC INCOME 900099 11116667 11116667 11116667 326438269 326148236 0 290033 X 1104261 1104261 87230 87230 5200010 5200010 863106 863106 354703 354703 819333 819333 1490225 1490225 41738 41738 87504 87504 3507576 3507576 1562389 1562389 1001784 1001784 8369174 8369174 254168 254168 UK PHYSICIANS' SALARIES 141116702 141116702 UK STAFF SALARIES & FRI 78494221 78494221 PROFESSIONAL DEVELOPMEN 26592831 26592831 BAD DEBTS 17105580 17105580 35798917 25917537 9881380 323851452 290331132 33520320 0 59118522 52120956 39907963 46751974 912453 953841 109355308 27452103 75593776 81903205 18016384 13129033 112162 67257 193661260 194926266 6898679 7767266 42291657 45966769 110961478 105095968 160151814 158830003 X 33509446 36096263 33509446 36096263 193661260 194926266 2586817 0 X X 0 1 X 1 0 X X X 1 UNIVERSITY OF KENTUCKY 616001218 6 1 323851452 0 1 323851452 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 A, LINE 2 THE UNIVERSITY OF KENTUCKY IS A GOVERNMENTAL ENTITY DESCRIBED IN 170(B)(1)(A)(V). 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 79696460 13381032 66315428 9827950 7582107 2245843 17764131 6488964 11275167 81903205 DUE TO UNIVERSITY OF KENTUCKY 20399184 DUE TO UNIVERSITY OF KENTUCKY MALPRACTICE FUND 17580432 DUE TO COLLEGE OF MEDICINE DEPARTMENTS 64808233 REFUNDS PAYABLE 190122 DUE TO THIRD PARTY PAYERS 2117997 105095968 1 TUITION SUPPORT FOR DEPENDENTS OF UK FACULTY MEMBERS 122 1104261 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 ANDREW PEARSON MD DIRECTOR 0 559138 0 0 0 1380 0 55423 0 10337 0 626278 0 0 BERNARD BOULANGER MD DIRECTOR 0 557043 0 0 0 2693 0 50685 0 10329 0 620750 0 0 CARMELL WALLACE MD DIRECTOR 0 373290 0 0 0 7620 0 38996 0 8800 0 428706 0 0 DARRELL JENNINGS MD DIRECTOR 0 427788 0 0 0 3960 0 42772 0 10323 0 484843 0 0 DARREN JOHNSON MD DIRECTOR 0 720040 0 0 0 28300 0 67797 0 10348 0 826485 0 0 DAVID MOLITERNO MD DIRECTOR 0 783680 0 0 0 18732 0 76298 0 10354 0 889064 0 0 EDWIN BOWE MD DIRECTOR 0 639450 0 0 0 7620 0 61856 0 8818 0 717744 0 0 ELIZABETH OATES MD DIRECTOR 0 629683 0 0 0 14735 0 63563 0 10342 0 718323 0 0 FREDERICK C DE BEER MD DIRECTOR 0 750244 0 0 0 7620 0 103277 0 5684 0 866825 0 0 JOSEPH ZWISCHENBERGER MD DIRECTOR 0 870280 0 0 0 3960 0 88098 0 10363 0 972701 0 0 KEVIN PEARCE MD DIRECTOR 0 326370 0 0 0 2580 0 32710 0 10314 0 371974 0 0 LARRY CARY MD DIRECTOR 0 232760 0 0 0 547 0 20551 0 5640 0 259498 0 0 LARRY GOLDSTEIN MD DIRECTOR 0 245000 0 0 0 2310 0 26250 0 3292 0 276852 0 0 LON HAYS MD DIRECTOR 0 356900 0 0 0 2580 0 34971 0 6504 0 400955 0 0 LOUIS BEZOLD DIRECTOR 0 292226 0 0 0 12148 0 29457 0 10312 0 344143 0 0 MARC RANDALL MD DIRECTOR 0 756086 0 0 0 2580 0 66782 0 8827 0 834275 0 0 MICHAEL KARPF MD DIRECTOR 0 2196193 0 0 0 14349 0 1392181 0 8850 0 3611573 0 0 MURRY CLARK DIRECTOR 0 593200 0 0 0 1393 0 81872 0 8813 0 685278 0 0 PATRICK MCGRATH MD DIRECTOR 0 548133 0 0 0 3960 0 51855 0 5670 0 609618 0 0 PHILIP TIBBS MD DIRECTOR 0 1178334 0 0 0 7620 0 111958 0 8862 0 1306774 0 0 RALEIGH JONES MD DIRECTOR 0 523902 0 0 0 3960 0 51803 0 5672 0 585337 0 0 ROGER HUMPHRIES MD DIRECTOR 0 491490 0 0 0 1380 0 45693 0 5665 0 544228 0 0 SCOTT STEVENS MD DIRECTOR 0 368468 0 0 0 2587 0 39724 0 7350 0 418129 0 0 SHAWN CAUDILL MD DIRECTOR 0 288766 0 0 0 2580 0 27480 0 10311 0 329137 0 0 STEPHEN STRUP MD DIRECTOR 0 573884 0 0 0 12148 0 52564 0 10338 0 648934 0 0 SUSAN MCDOWELL DO DIRECTOR 0 409450 0 0 0 1380 0 38654 0 5660 0 455144 0 0 WENDY HANSEN MD DIRECTOR 0 551125 0 0 0 25496 0 56532 0 10335 0 643488 0 0 CRAIG COLLINS DIRECTOR 0 279055 0 0 0 0 0 29698 0 277 0 309030 0 0 MOTTI EDELSTEIN DIRECTOR 0 325464 0 0 0 0 0 32729 0 10309 0 368502 0 0 PEGGY SUSAN HALCOMB DIRECTOR OF BILLING OPERAT 221023 0 0 0 0 0 0 0 21721 0 242744 0 0 0 JAMES M TILLETT DIRECTOR OF INFORMATION TE 179325 0 0 0 0 0 0 0 17905 0 197230 0 0 0 KATERINA MOLINA DIRECTOR OF FINANCE & ACCOUNTING 152760 0 0 0 0 0 0 0 15248 0 168008 0 0 0 ELAINA GRUBER CHILD OF EXECUTIVE DIRECTOR 5546 SCHOLARSHIP KELSEY JOHNSON CHILD OF BOARD MEMBER 16476 SCHOLARSHIP LAUREN JOHNSON CHILD OF BOARD MEMBER 16476 SCHOLARSHIP BENJAMIN MOLITERNO CHILD OF BOARD MEMBER 10006 SCHOLARSHIP NATHANIEL MOLITERNO CHILD OF BOARD MEMBER 10930 SCHOLARSHIP CECILIA WINFREY CHILD OF BOARD MEMBER 11092 SCHOLARSHIP KYLE BEZOLD CHILD OF BOARD MEMBER 5384 SCHOLARSHIP JONATHAN HUMPHRIES CHILD OF BOARD MEMBER 11092 SCHOLARSHIP MADELINE HUMPHRIES CHILD OF BOARD MEMBER 11092 SCHOLARSHIP DAVID STEVENS CHILD OF BOARD MEMBER 5546 SCHOLARSHIP RILEY FERGUSON CHILD OF BOARD MEMBER 5546 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 B, LINE 11 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 IX, LINE 24E ACADEMIC ENRICHMENT: PROGRAM SERVICE EXPENSES 10,561,545. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,561,545. MISCELLANEOUS EXPENSE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 9,881,380. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,881,380. MALPRACTICE INSURANCE: PROGRAM SERVICE EXPENSES 9,096,333. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,096,333. CAPITAL & CURRENT OPERATING EXPENSE: PROGRAM SERVICE EXPENSES 3,514,743. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,514,743. UK PHYSICIANS' FRINGE BENEFITS: PROGRAM SERVICE EXPENSES 2,168,956. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,168,956. KY CLINIC CENTRAL: PROGRAM SERVICE EXPENSES 450,785. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 450,785. KY CLINIC SOUTH EXPENSES: PROGRAM SERVICE EXPENSES 125,175. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 125,175. 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